Case 9:08-cv-80736-KAM Document 317 Entered on FLSD Docket 03/12/2015 Page 1 of 4Pay By Mail -- Please detach and return bottom scut
Case File
efta-efta01195207DOJ Data Set 9Otherid Cornell
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta01195207
Pages
1
Persons
0
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Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
id Cornell
3 Service Date(s) From / Through
01/14/15
2 Account Number
Statement Date
Pa se
02/18/15
6
This is the current insurance information on file
9
'1'1'1'11144
Please review and make corrections on the back of this form
Insurance Name
7
CHECK/M.O.
ACCT. BALANCE
$
V05.22
$
AMT. ENCLOSED
NEVVYORK-PRESBYTERIAN HOSPITAL
PO BOX 9305
NEW YORK, NY 10087-9305
I
1111111111111111111
653585A (PC
EFTA01195207
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