EFTA02413097.pdf

4;P-7)3-2009 10:164 FFCClaiR 'HUT / +S m9%441 2123979008 ,61-- graAllA Thomas J. Magnani D.D.S. Alvin Grayson D.O.S. 7 West 51st Street 7th Floor New York NY 10019 Jeff Epstein St Thomas Virgin Islands 00802 TO:16467067223 t Telephone: I pops ty OWN at inn Iron INN Pre o ne weir° Du MT II owl below Cal Vs, Winn 3.0 Goa Date I 4/30/2009 Account 9118 Remittance rapenikin . KO= DtT CH intA /CROON NC AC Tow WIN YpvN TICTaTiMee TO Watt CRWI TO PTTOTIA COUNT Date Pant Descnpuen Charges Credits Balance Previous Balance 0.00 4/21/2009 Comprehensive Oral oval 50.00 50.00 4/21/2009 FMS with Bite wings 175.00 225 00 4/21/2009 Bite Wings 4 Films 65.00 290.00 4/21/2009 Adult Scale & Prophy 160.00 450.00 4/21/2009 Fluorid 12 00 462.00 4/22/2009 AMERICAN EXPRESS 462.00 0.00 4/29/2009 1 Periapical X Ray 25.00 25 00 4/29/2009 Amalgam 4+ Surface Perm. 425.00 450.00 4/29/2009 Amalgam 4+ Surface Perm 425 00 875 00 Account Total 875.00 Wo accept credit cards You may complete and return the top part of this statement, or call the office at 212888.1090. Current j 30 lint 60 Dayc 00 Dayc 120* Days — 875.00 I 0.00 0.00 0.00 0.00 'Mortal J P.tagr 0 D.S. Malt Dimon D.D.S. 7 West Slit Steel 719 Floor Now Yea NY 10019 EFTA_R1_01475376 EFTA02413097