EFTA01122966.pdf

HISTORICAL STATEMENT 12/1/2014 to 3/3/2015 Thomas J. M8 Telephone: Alvin Ora son Mr. Jeff Epstein De Account 9 East 71st Street 3/3/2015 10345 New York NY 10021 neretreee ' -. IMPORTANT - MUSE GEM:MU/9ER PORTIONMID RETURNMTN YOUR IttSITTANTE TO INSURE CREDIT TO PROPER ACCOUNT Charges Credits Balance 7/16/2014 Previous Balance 0.00 12/23/2014 40.00 40.00 12/23/2014 180.00 220.00 12/23/2014 24.00 244.00 12123/2014 65.00 309.00 2/25/2015 475.00 784.00 2/25/2015 476.00 1,259.00 746a tr peudlibt o3/ 6 kn Account Total 1,259.00 Patient Charges ,269.00 Patient Payments 0.00 Patient Credits o.00 Patient Debit') o.00 We accept credit cards You may comPlete alt of this statement, or call the office a Current 30 Osp CO Days ] 90 Days 120« Days 950.00 0.00 309.00 0.00 0.00 Mans J. Magrawl Alvin Grayson 00.8. M. EFTA01122966  STATEMENT Thomas J. Ma Telephon Alvin Grayson V mai try MS ant.et hi avowIns Peg In Swears tox • NA Sbt Sin Mrs Cede MOS Sinks 4MPs Mr. Jeff Epstein Otto 1 Account 9 East 71st Street 7/29/2015 New York NY 10021 10345 RamOtatioe atacanntrs • $&ME CiEtACHuartur PCRIOINC RETuRNMrtN TOUR ISOITTAPCX TONSURECAM TO PROMS ACCOUNT Date Patient Description Charges Credits Balance 7/1/2015 lance 0.00 7/9/2015 40.00 40.00 7/9/2015 180.00 7/9/2015 220.00 1,500.00 1.720.00 fat 0 c 694027,/, ti n A—fru ty -c.) U. t ( & 14/-- CA9rt t.7., Account Total 1,720.00 It payment has been sent, please disregard this statement - Thank You. We accept credit cards You maycompletetilaroDaysp part of this statement, or call the office a Current 30 Days so clays 120+ Days 1,720.00 0.00 0.00 0.00 0.00 Thomas J. Macron; Alvin Grayson EFTA01122967  STATEMENT Thomas J. Ma Telephone Alvin Grayso poyIn by cedd cad. waft Ur, orrRunl you re rsM in Ye nywIlawca boA aid EV out below. Moolortall Vito Amu Cards EN, Ore Scoots° So Cato Mr. Jeff Epstein Date Account 9 East 71st Street 3/2/2016 10345 New York NY 10021 Remittance pApoRTANT . PLEASE DETACH TIPPER PORTION NA RERAN YAR1 YOUR REMITTANCE TO INSURE CREOIT TO PROPER ACCOVNT Date Patient Description Charges Credits Balance 1/27/2016 Previous Balance 0.00 2/3/2016 40.00 40.00 2/3/2016 180.00 220.00 2/3/2016 65.00 285.00 Account Total 285.00 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 285.00 0.00 0.00 0.00 0.00 Thomas J. Magnani M. Alvin Grayson M. EFTA01122968