Thomas J. M8 Alvin Ora son Mr. Jeff Epstein 9 East 71st Street New York NY 10021 HISTORICAL STATEMENT 12/1/2014 to 3/3/2015 Telephone: De Account 3/3/2015 10345 neretreee ' -. IMPORTANT - MUSE GEM:MU/9ER PORTIONMID RETURN MTN YOUR IttSITTANTE TO INSURE CREDIT TO PROPER ACCOUNT Charges Credits Balance 7/16/2014 12/23/2014 12/23/2014 12/23/2014 12123/2014 2/25/2015 2/25/2015 Previous Balance 40.00 180.00 24.00 65.00 475.00 476.00 746a tr peudlibt o3/ 6 kn 0.00 40.00 220.00 244.00 309.00 784.00 1,259.00 Account Total 1,259.00 Patient Charges Patient Payments Patient Credits Patient Debit') We accept credit cards You may comPlete alt of this statement, or call the office a Current 30 Osp CO Days 90 Days 950.00 0.00 309.00 ] 0.00 Mans J. Magrawl Alvin Grayson 00.8. ,269.00 0.00 o.00 o.00 120« Days 0.00 EFTA01122966 Thomas J. Ma Alvin Grayson Mr. Jeff Epstein 9 East 71st Street New York NY 10021 STATEMENT Telephon V mai try MS ant. et hi avow Ins Peg In Swears tox • NA Sbt Sin Mrs Cede MOS Sinks 4MPs Otto 1 Account 7/29/2015 10345 RamOtatioe atacanntrs • $&ME CiEtACH uartur PCRIOINC RETuRN MrtN TOUR ISOITTAPCX TONSURECAM TO PROMS ACCOUNT Date Patient Description Charges Credits Balance 7/1/2015 7/9/2015 7/9/2015 7/9/2015 -c.) lance ti n U. t ( &14/-- CA9 rt t.7., 40.00 180.00 1,500.00 c fat A—fru 0 694027/, ty 0.00 40.00 220.00 1.720.00 , Account Total 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 1,720.00 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 Alvin Grayso Mr. Jeff Epstein 9 East 71st Street New York NY 10021 Telephone 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 Date Account 3/2/2016 10345 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 2/3/2016 2/3/2016 2/3/2016 Previous Balance 40.00 180.00 65.00 0.00 40.00 220.00 285.00 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