STATEMENT Thomas J. Ma Alvin Gra son Mr. Jeff Epstein 9 East 71st Street New York NY 10021 Telephon a AEON by asS GAM fl it iha mewl SY Si tette b M riltanCeeo»PIR a as beRm IluPwanS MAE Ins OSA Re Oslo Scant 6a Cede Date Ao:ount 4/30/2015 10949 Remittance WPORTART MEW DETACH UPPER PORTION MD RETURN WM YOUR REMTITMCE TO INSURE CREW TO PROPER ACCOUNT Date Patient Description Charges Credits Balance 4/6/2015 4/6/2015 4/6/2015 Previous Balance 60.00 180.00 200.00 0.00 60.00 240.00 440.00 Account Total 440.00 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 120+ Days 440.00 0.00 0.00 0.00 0.00 Thomas A Magnani M . Alvin Gmyson EFTA01122969