Insured's Name:

Insured's Name: TERJE ROD LARSON Please Address Inquiries to: Caring People 118-35 QUEENS BLVD. 1st Floor Forest Hills, NY 11375 Call: 00 - CaringPeople Invoice No: 245243 0 ALWAYS COSINICTFO - Ls! 'Wein NI.‘$.(1 & Fl. *** COPY *** Client Original Invoice Invoice Date: 05/02/2018 Service Dates: 04/21/2018 - 05/04/2018 Policy No: Invoice Total 148.50 Printed: 5/2/2018 Client Responsibility S148.50 04/27/2018 Fri I HHA BALANCE DUE I I BERYL THOMAS 5.50 I 27.00 $148.50 HR 148.50 I Page 1 of 1 5.50 $148.50 Aging This Invoice 0-30 31.60 61-90 Older than 90 Total Amount $148.50 $0.00 $0.00 $0.00 $0.00 $ 0.00 CaringPeople , who], N1 NI 1 I& FL Remit Payment To: Caring People 5300 WEST ATLANTIC AVE. SUITE 203 DELRAY, FL 33484 TERJE ROD LARSON Enclosed Amount: Caring People Balance Due: S148.50 Client Name: TERJE ROD LARSON Invoice No: 245243 Invoice Date: 05/02/2018 EFTA00302088