Thomas J. Magnani D.D.S. Telephone Mr. Jeff Epstein 9 East 71st Street New York NY 10021 IIp, yrg by mob' COM. Mot the Mani you we PITON AT RA below MaNercon1 Ku Mes Card" Date V29/2015 IMPORTANT. PLEASE DETACH UPPER PORTION AND RETURN WIN YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits 7/1/2015 7/1/2015 7/1/2015 ' lance 40.00 180.00 Account Total 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 212-688-1090. Current 30 Days 60 Days 90 Days 1 220.00 0.00 0.00 0.00 Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7111 Floor New York NY 10019 (212) 688 EFTA_R1_02114333 EFTA02709159