MAY-12-2011 09:50A FROM: CR THOMAS MAGNANI 1 I Thom Magnanl D.D.S. Alvin son D.D.S. New Mr. Jet 301 East Apt 10p New YOr Date 11/22/2010 11/22/2010 11/22/2010 12/1312010 12/1312010 12/14/2010 12/14/2010 12/17/2010 12/20/2010 1/7/2011; 1/7/2011 1/14/2011 1/21/2011 1/25/2011 2/10/2011 3/2/2011. 4/21/2011 4/21/2011 4/21/201 j Page 1 C 10019 stein th Street NY 10065 ones D.D.S. Balan TO:16467067223 P.1/2 tea_ -c_-_S HISTORICAL STATEMENT 11/22/2010 to 4/30/2011 Telephone: Date Account 5/12/2011 Charges Credits Balance 175.00 325.00 375.00 275.00 275.00 50.00 160.00 1,425.00 1,850.00 2,300.00 2,300.00 0.00 1,850.00 1,850.00 25.00 375.00 925.00 925.00 1,900.00 0.00 175.00 500.00 875.00 1,150.00 1,425.00 1,475.00 1,635.00 210.00 2,060.00 4,360.00 6,660.00 6,660.00 4,810 00 6,660.00 6,685.00 7,060.00 7,985.00 8,910.00 10,810.00 Continued 90 Days 120+ Days New York NY 10019 EFTA00597014 MAY-12-2011 09:51A FROM:OR THOMAS HAGMANI I I i mom Alvin Magnanl D.D son D.D.S. NY 10019 Mr. Jeff stein Apt 10 301 E7 th Street New Y4 NY noes TO:16467067223 P.2'2 HISTORICAL STATEMENT 11/22/2010 to 4/30/2011 Telephone: Date Account 5/1212011 Date ', [Pr lent DecrIptIon l i Charges Credits Balance 4/21/2011 1,900.00 12,710.00 • } i I i 1 i I I i t I 1 e ; I ii, I Page 2 1 1 I Account Total 12,710.00 1 Patient Charges 15,986.00 Patient Payments 3,275.00- S Patient Credits 0.00 1 ) tl Patient Debits 0.00 Cutrent i. 30 Days so Days 90 Days 120+ Days E I I f i . : I Thomas( 41 nani D.D.S. Grayeon D. D S. Now York NY 10019 EFTA00597015