STATEMENT

STATEMENT Thomas J. Maar Alvin Grayson Mr. Jeff Epstein 9 East 71st Street New York NY 10021 Telephone: peetho by ctedil MIL erne, the ,mew you ere pow., el OM fellablell Maw' Po ou 001m Itesseard Vaa AREA Card • ENE OS Snneture Date Sc Code Account 10765 1/7/2015 RemItbnce IMPORTANT • PLEASE DETACH UPPER PORTION ARO RETURN WITH YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 11/26/2014 12/22/2014 ItZ,8O/ Previous Balance 2,100.00 0.00 2,100.00 Account Total 2,100.00 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 0.00 120+ Days 0.00 2,100.00 0.00 0.00 Thomas J. Magnanl Alvin Grayson =. 212)688.1090 EFTA01122961 HISTORICAL STATEMENT 2/3/2015 to 3/17/2015 Thomas J. Ma Alvin Grayson Mr. Jeff Epstein 9 East 71st Street New York NY 10021 Telephone Date Account I 3/17/2015 10765 Remittance L__ DIPORTANT PLEASE DETACH UPPER PORTKM MD RETURN WTI YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 1/29/2015 Previous Balance 0.00 2/3/2015 325.00 325.00 3/3/2015 375.00 700.00 316/2015 25.00 725.00 3/6/2015 24.00 749.00 Account Total 749.00 Patient Charges 749.00 Patient Payments 0.00 Patient Credits 0.00 Patient Debits 0.00 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 120+ Days 424.00 326.00 0.00 0.00 0.00 Thomas 3. Magnani M. Alvin Grayson-. EFTA01122962 STATEMENT Thomas J. Ma Mr. Jeff Epstein 9 East 71st Street New York NY 10021 Telephone: ■psylns by NAM cat AMR RP want )0./ Ns pmts., Tr weidpnos box aid SI mg Dorm hissloncartl Arno* Caen Els OM. Sonserp CPS Date Account 4/30/2015 10765 Remittance IMPORTANT • PLEASE DETACH UPPER PORTION NC RETURN NTH TOUR REMITTANCE TO INSURE CRITOIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 3/26/2015 3/27/2015 3/27/2015 4/10/2015 j41 BS' cf Previous Balance Gol.ii 0 A. , Soot" 2 oc., 180.00 40.00 7,500.00 'co 0.00 180.00 220.00 7,720.00 Account Total 7,720.00 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 a Current 30 Days 60 Days 90 Days 120+ Days 7,720.00 0.00 0.00 0.00 0.00 Thomas J. Magnate= Alvin Grayson M. EFTA01122963 STATEMENT Thomas J. Ma Alvin Gra so Mr. Jeff Epstein 9 East 71st Street New York NY 10021 Telephone .Si Ir c a ty =it card. ever the crawl yca as pratIn x reancsa be' and ra our treaw. Mau/scam Vsa Amex Card • Erc Dna Warta aa Co* Date Account 3/2/2016 10765 Remittance ta.PORTANT P.Caaa DETACH UPPER PORIION AND RETURN witirYoun REM-RANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 1/27/2016 2/25/2016 2/25/2016 2/25/2016 Previous Balance 40.00 160.00 0.00 0.00 40.00 220.00 220.00 Account Total 220.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards! You may complete this statement, or call the office Current 30 Days ! 60 Days 90 Days 120i. Days 220.00 0.00 0.00 0.00 0.00 Thomas J. Magoon'''. Alvin Grayson_. 7 EFTA01122964 STATEMENT Thomas J. Ma nani Alvin Grayson Mr. Jeff Epstein 9 East 71st Street New York NY 10021 Telephone poVrai by opal cant MIN foe amount yco aro psying M To roma:Ana boo a4 Si OA teCIY. Wavercons via Miss Card el Tip Dite ScnotNe SC CoLo Date Account 4/27/2016 10765 Remittance ATPORTNJT • PLEASE OETACIT LAVER PORDON ANO RETURN WIN YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 3/30/2016 4/6/2016 lance sA (Pk 1 &- 17;51- tf kliv 1,100.00 (6 t O° „turf el 0.00 1,100.00 Account Total 1,100.00 If payment has been sent, please disregard this statement - Thank You. We accept credit cards You may complete rt of this statement, or call the office a Current 30 Days 60 Days 90 Days 120+ Days 1,100.00 0.00 0.00 0.00 0.00 Thomas J. Magnani=1. Akin Grayson- EFTA01122965