EFTA00311355.pdf

Statement of Account EMD PC JEFFREY EPSTEIN 9 EAST 71ST STREET NEW YORK, NY 10021 Date Account No. I Page # I 01/28/2015 0000008048 1 Last.Payment Date Amount // 0.00 Paid by Paid By Date Procedure Description Charges Insurance Patient Adj. Balance 01/22/2015 99205 New Pt High Complexity 500.00 500.00 01/22/2015 11100 Biopsy/Skin, 1st 250.00 250.00 01/22/2015 17000 Dest Ben/Premalig 1st 175.00 175.00 01/22/2015 17003 Dest Ben/Premal 2-14 350.00 350.00 0 - 30 Days `31 - 60 Days d 61 - 90 Days 91 - 120 Days ›. 120 Days Parent Current i Past Due Past Due Past Due Past Due Balance Due j L $1275.00 $0.00 1 so.00 $0.00 $0.00 $1275.00 Notes: CUT ON DOTTED LINE AND SEND WITH PAYMENT FOR BILLING INQUIRIES CONTACT For your convenience, you may transfer this balance to your credit card account. To pay with your credit card, please complete the information below: 0 Olt E Lac Amt. No. Exp. Date Security Code Amount Signature EPSTEIN. JEFFREY ACCOUNT NO. 0000008048 Statement Date: 01/28/2015 payable to: MITCHELL A KLINE, MD PC EFTA00311355 Statement of Account ERD PC JEFFREY EPSTEIN 9 EAST 71ST STREET NEW YORK, NY 10021 Date Procedure Description Date I Account No. J Paget' 01/22/2015 f 0000008048 1 Last Payment Date Amount 0.00 Paid by Charges Insurance 01/22/2015 01/22/2015 01/22/2015 01/22/2015 99205 11100 17000 17003 New Pt High Complexity Biopsy/Skin, 1st Dest Ben/Premalig 1st Dest Ben/Premal 2-14 1 .AA g 1‘ S o y 500.00 250.00 175.00 50.00 Paid By Patient Adj. Balance 500.00 250.00 175.00 50.00 0 - 30 Days Current 31 - 60 Days Past Due 61 - 90 Days Past Due 91 - 120 Days Past Due > 120 Days I Past Due $975.00 $0.00 $0.00 $0.00 $0.00 Notes: Patient Balance Due $975.00 CUT ON DOTTED LINE AND SEND WITH PAYMENT FOR BILLING INQUIRIES CONTACT Please remit payment of $975.00 payable to: EPSTEIN, JEFFREY ACCOUNT NO. 0000008048 Statement Date: 01/22/2015 , MD PC EFTA00311356 You have an appointment with dermatologist, Dr. on friday Dec. 9th at 3pm. He does not accept any insurance. (i have cancelled the appt w r. Dr. Jojo, Jeffrey will probably walk but will need you to take him to his haircut at Fekkai salon afterwards...be sure to have the car out. Fri. Jan, 9, 2015 PB-NY Reminder: to fly from PB to NY via Jet Blue#544 at 11:04am, arrive Newark 1:49pm (booked w/Jet Blue Confirm#MQU$BA) TBD Depart PB TBD Arrive NY TBD Hardeep 3:00pm Appt w/Dr. Mitchell Kline 4:30pm Haircut w/Patrick at salon EFTA00311357 From Subject: Dr. Mitchell Kline-Dermatologist Date: December 313, 2014 at 12:20 PM To: Jeffrey Epstein eevaca* nn.:. rna Cc: EFTA00311358