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