Thomas J, Magnani D.D.S. STATEMENT Alvin Grayson D.D.S. 7 West 51st Street it peyieg by credi card, enter the amount you are paying in Be remifience box and | 7th Floor lo New York NY 10019 nein Card ¢ ne | Signaure Se Code Jeff Epstein | Date Account 9 East 71st Street | _ 10/29/2015 New York NY 10021 Remittance | IMPORTANT - PLEASE DETACH UPPER PORTION AND RETURN WITH YOUR REMITTANCE TO INSURE CREDIT TO PROPER ACCOUNT 9/30/2015 3,000.00 525.00 220.00 9/30/2015 | Jeff Account Total 3,525.00 | If payment has been sent, please disregard this statement - Thank You. 9/30/2015 | Jeff We accept credit cards! You may complete ‘op part of this statement, or call the office a 10/20/2015 | Jeff Thomas J. Magnani 0.0.S. Alvin Grayson 0.0.S. 7 West Stst Street 7th Floor New York NY 10019 EFTA00311439