Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street STATEMENT Telephone: psr by am6I net ONE Me PaHunl pep VP mimeses somPlarms box ad 7th Floor • PA blow MaplaimA Ws Oa New York NY 10019 Ceti Ea OS Oman MEOW Jeff Epstein Date Account 9 East 71st Street 1126/2014 New York NY 10021 Remittance IMPORTANT - PLEASE DETACH UPPER PORTON NC REMAIN VAT/4 YOUR RENOUNCE TO INSURE CREDIT TO PROPER ACCOUIIT Date Patient Description Charges Credits Balance P %/1 out". km 7442cscot r eatift, loiticipi{ If payment has been sent, please disregard this We accept credit cards You may complete a this statement, or call the office a1 statement Account Total - Thank You. top part of Current 30 Days 60 Days 90 Days T — 120+ Days 0.00 0.00 0.00 , i 0.00 Thomas J. ItagnaM O.D.S. AMn Grayson D.O.S. 7 West Slat Street 7th Floor New York NY 10019 EFTA00603935