MAY-12-2811 @9:S@AR FROM:DR THOMAS MAGNANI F ! Mr, Jeff Bypstein , 301 East $6th Street 11/22/2010 11/22/2010 11/22/2010 12/13/2010 12/13/2010 12/14/2010 12/14/2010 12/17/2010 12/20/2010 1/7/2011 1/7/2011 1/14/2011 1/21/2014 1/25/2014 2/10/2014 3/2/2011 4/21/2011 4/21/2011 4/21/2011 Page 1 Apt 10F | New Yor FINY 10065 | Fi ! { ANip Grayson D.D qi is | 2 fn y Spee oe Seas AR. a TO: 16467867223 P.1 OQ ¢A4ItTSN HISTORICAL STATEMENT Date 175.00 325,00 375.00 275.00 275.00 50.00 160.00 1,850.00 2,300.00 2,300.00 0.00 1,850.00 25.00 375.00 925.00 925.00 §/12/2011 11/22/2010 to 4/30/2011 Balance 0.00 175.00 §00.00 875.00 1,150.00 1,425.00 1,475.00 1,635.00 210.00 2,060.00 4,360.00 6,660.00 6,660.00 4,810.00 | 6,660.00 6,685.00 7,060.00 7,985.00 8,910.00 10,810.00 1,425.00 1,850.00 | Continued 120+ Days New York NY 10019 [x EFTA00597014

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MAY-12-2811 @9:51A FROM:DR THOMAS MAGNANI ut ' Thomas Alvin Grayson D.D.S. New Yorignv 10019 ee eee TO: 16467067223 P.eve HISTORICAL STATEMENT ‘ | 11/22/2010 to 4/30/2011 eer ee SBIR SS o Patient Charges Patient Payments Patient Credits Patient Debits New York NY 10o1o [II [Date Account seo | i : b : Telephone: PY Balance 12,710.00 15,985.00 3,275.00- 0.00 0.00 EFTA00597015