EFTA00603321.pdf

STATEMENT Thomas J. Magnani D.D.S. Telephone: Alvin Grayson D.D.S. 7 West 51st Street ■ barn; by cede c.d. Itt he Maur; you ere pang en Me tometance tat and IA out below 7th Floor Mastercard time Amex New York NY 10019 Card I/ Esit OiN Sponse Sy Cede Mr. Jeff Epstein Date Account 301 East 66th Street 1/28/2011 Apt 1OF Remittance New York NY 10065 IMPORTANT • PLEASE MAPS UPPER PCITTION AND RETURN WITH YOUR RIDATIANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 1/5/2011 Previous Balance Account Total 6,660.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards! You may complete and return the top part of this statement, or call the office at Current 30 Days 60 Days 90 Days 120+ Days 6,460.00 210.00 0.00 0.00 0.00 Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor Now York NY 10019 EFTA00603321