Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street STATEMENT Telephone: psr by am6I net ONE Me PaHunl pep VP mimeses somPlarms box ad 7th Floor • PA blow MaplaimA Ws Oa New York NY 10019 Ceti Ea OS Oman MEOW Jeff Epstein Date Account 9 East 71st Street 1126/2014 New York NY 10021 Remittance IMPORTANT - PLEASE DETACH UPPER PORTON NC REMAIN VAT/4 YOUR RENOUNCE TO INSURE CREDIT TO PROPER ACCOUIIT Date Patient Description Charges Credits Balance P %/1 out". km 7442cscot r eatift, loiticipi{ If payment has been sent, please disregard this We accept credit cards You may complete a this statement, or call the office a1 statement Account Total - Thank You. top part of Current 30 Days 60 Days 90 Days T — 120+ Days 0.00 0.00 0.00 , i 0.00 Thomas J. ItagnaM O.D.S. AMn Grayson D.O.S. 7 West Slat Street 7th Floor New York NY 10019 EFTA00603935 Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor STATEMENT Telephone: payag by ma owe. nuer en 'moat yen aro porn FM teniuma boy are1 out bekw. Iniskand V10 Amu New York NY 10019 Ord • bp Dna SIgnobse SKI Can Jeff Epstein Date 9 East 71st Street 6/3/2015 New York NY 10021 Remelenom SIPORTANT . RAMC MACH UPPER PORTION MO MOURN NTH YOUR REMITTANCI TO MUM CREPT TO PROM ACCOUNT Date Patient 3 Description pou9 s. Charges Credits 0,4v Balance Account Total If payment has been sent, please disregard this statement - Thank You. We accept credit cards! You may complete top part of this statement, or call the office a Current 30 Days 60 Days 90 Days 120+ Days 0.00 0.00 0.00 0.00 Thomas J. Magnani O.D.S. AMa Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA00603936 Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 61st Street 7th Floor STATEMENT Telephone soya,' by alai ma Nam Pamoat yet ars ay" in MT ranitina tat aid OW Dana New York NY 10019 Nalstatd Afiter/ Ord Hl Omar soave so Cost Jeff Epstein Date 9 East 71st Street 9/30/2015 p New York NY 10021 Renton* A4PORTANT • PLEAS( DETACH UPPER PORTION MO RETURN VATH YOUR REISTTNK€ TO INSVII5 MOTT 10 PROPER ACCOUNT Date Patient Description Charges Credits Balance Account Total If payment has been sent, please disregard this statement - Thank You. We accept credit cards! You may complete top part of this statement, or call the office at i Current 30 Days 60 Days 90 Days 120+ Days 0.00 0.00 0.00 0.00 Thomas J. Magner)] D.O.S. Alvin Grayson D.O.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA00603937 STATEMENT Thomas J. Magnani D.D.S. Alvin Grayson D.O.S. 7 West 51st Street 7th Floor New York NY 10019 Jeff Epstein 9 East 71st Street New York NY 10021 Telephone: pan by nal tent car Na aTa.ni m dm PanrqnRa annOnc• box rd oul twcw, Maaanorti Va. Amu Cad• EipOW &amour, N2 Code Date Account 10/29/2015 M Remittance IMPORTANT • PLEASE DETACH UPPER PORTION MO RETURN Will YOUR RFJaITANCE TO INSURE CREOR TO PROPERACCOUNT Date Patient Description Charges Credits Balance Account Total 3,525.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete top part of this statement, or call the office at Current 30 Days 60 Days 90 Days 120+ Days 0.00 0.00 0.00 0.00 Thomas J. Magnari D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA00603938 Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 61st Street 7th Floor New York NY 10019 Jeff Epstein 9 East 71st Street New York NY 10021 HISTORICAL STATEMENT 1/5/2016 to 2/24/2016 TelephoneMIM Date 2/24/2016 Rometanoe IMPORTANT PLEASE (DETACH UPPER PORTION AND RETURN IM111 YOUR RETATTANCE TO INSURE ClcsOR TO PROPER ACCOUNT Date Patient Description Charges Credits Balance Account Total 0.00 Patient Charges Patient Payments Patient Credits 0.00 Patient Debits 0.00 We accept credit cards You may complete top part of this statement, or call the office atill. Current 30 Days 60 Days 90 Days 120+ Days 0.00 0.00 0.00 0.00 0.00 Thomas .1. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA00603939 STATEMENT Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 61st Street 7th Floor New York NY 10019 Jeff Epstein 9 East 71st Street New York NY 10021 Telephone: I payee by Groat cad. Filet tie amount you en WAD IA me recalaRta OP[ Si ISout bad/. APAstarad %Ma Nati Calf I gip Da Drain Ski Coar Oate 3/30/2016 p Ramat:ince alPONTAN1 • PLEASE DETACH UPPUR POIItO'J N40 RUT LAIN WIN YOUR HEHATTNCE TO ENSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance Account Total If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete top part of this statement, or call the office at . Current 30 Days 60 Days 90 Days 120« Days 0.00 0.00 0.00 0.00 Thomas J. Magnanl D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 EFTA00603940