Thomas J. M8 Alvin Ora son Mr. Jeff Epstein 9 East 71st Street New York NY 10021 HISTORICAL STATEMENT 12/1/2014 to 3/3/2015 Telephone: De Account 3/3/2015 10345 neretreee ' -. IMPORTANT - MUSE GEM:MU/9ER PORTIONMID RETURN MTN YOUR IttSITTANTE TO INSURE CREDIT TO PROPER ACCOUNT Charges Credits Balance 7/16/2014 12/23/2014 12/23/2014 12/23/2014 12123/2014 2/25/2015 2/25/2015 Previous Balance 40.00 180.00 24.00 65.00 475.00 476.00 746a tr peudlibt o3/ 6 kn 0.00 40.00 220.00 244.00 309.00 784.00 1,259.00 Account Total 1,259.00 Patient Charges Patient Payments Patient Credits Patient Debit') We accept credit cards You may comPlete alt of this statement, or call the office a Current 30 Osp CO Days 90 Days 950.00 0.00 309.00 ] 0.00 Mans J. Magrawl M . Alvin Grayson 00.8. ,269.00 0.00 o.00 o.00 120« Days 0.00 EFTA01122966