STATEMENT

STATEMENT Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7th Floor New York NY 10019 Mr. Jeff Epstein P.O. Box 806 New York NY 10150 C@w91 qcflubi Telephone: ■ paying Wage art were re aroma VW OM 0.0.3 n MI "tea Na Gni a out below Sand Na Para Ord Snob &raisin 310 Cab Dale Account Remittance NPORTAHT - PLEASE DETACH UPPER PORTION NOD RETURN WITH YOUR RE/CNC! TO NSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance ions Balance i AI Account Total 1,520.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete a top part of this statement, or call the office at Current 30 Days 1,520.00 0.00 60 Days 90 Days 0.00 0.00 Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7111 Boor New York NY 10019 120+ Days 0.00 EFTA00640853