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Statement of Account MITCHELL A KLINE, MD PC 700 PARK AVENUE NEW YORK, NY 10021 JEFFREY EPSTEIN 9 EAST 71ST STREET NEW YORK, NY 10021 110%, :Wait 02/05/2015 I 0000008048 1 02/05/2015 1275.00 Paid by Paid By Date Procedure Descripti
Online Batch:: Coato.n. Coe, TWIN NW' 500.00 260.00 176.00 350.00 $0.00 $0.00 CUT ON DOTTED LINE AND SEND WITH PAYMENT )NTACT menssalliM EPSTEIN, JEFFREY ACCOUNT NO. 0000008048 Statement Date: 02/05/2015 Please remit payment of $0.00 payable to: MITCHELL A Kt I NE, MD PC EFTA00282964
Batch:: Coato.n. Coe, TWIN NW' 500.00 260.00 176.00 350.00 $0.00 $0.00 CUT ON DOTTED LINE AND SEND WITH PAYMENT )NTACT menssalliM EPSTEIN, JEFFREY ACCOUNT NO. 0000008048 Statement Date: 02/05/2015 Please remit payment of $0.00 payable to: MITCHELL A Kt I NE, MD PC EFTA00282964 1500 HEA
5 01222015 99205 11100 17000 17003 nit..-.. A n.tne N n. 729 PCS AVM 1611 new. in• 16321 IIIIIIIf New Pt High Complexity Biopsy/Skin, 1st Dest Ben/Premalig 1st Dest Ben/Premal 2-14 herthemt MESS:332443 Try ID: 51,302443 Rirf II: Won Phone Order turoutia pEk Entn NS& !trial Tote: $ 1.21N Ritt
Statement of Account MITCHELL A KLINE, MD PC 700 PARK AVENUE NEW YORK, NY 10021 JEFFREY EPSTEIN 9 EAST 71ST STREET NEW YORK, NY 10021 Date Procedure Description ingatMli WAregiiiiNOSIN .R. 02/26/2019 0000008048 1 Br trallipaMOVONO a
liteAtt,tpi mat tatyr $0.00 $199.88 $0.00 $0.00 $0.00 Notes: CUT ON DOTTED LINE AND SEND WITH PAYMENT FOR BILLING INQUIRIES CONTAC EPSTEIN, JEFFREY ACCOUNT NO. 0000008048 Statement Date: 02/26/2019 Please remit payment of $199.88 payable to: MITCHELL A KLINE, MD PC EFTA00292227 Statement
$0.00 > 120 Days Past Due $0.00 Notes: Patient Balance Due $650.00 CUT ON DOTTED LINE AND SEND WITH PAYMENT FOR BILLING INQUIRIES CONTACT EPSTEIN, JEFFREY ACCOUNT NO. 0000008048 Statement Date: 02/01/2019 Please remit payment of $650.00 payable to: VISA MC AMEX Acct.*, Exp. Date Sig
Description Paid by Charges Insurance Paid By Patient Adj. Balance 01/11/2019 01/11/2019 99212 17000 Established Pt Visit Straightfwrd Dest Ben/Premalig 1st 250 25'.00 250.00 250.00 01/11/2019 17003 Dest Ben/Premal 2-14 50.00 150.00 A Gate- 1,,ni- efruct, ivtt 4 -c c) 0 el 0-- 04- tecil vt
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 Pai
o 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 EPST
atient 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 De
0 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 D
Entities connected to both Jeffrey Epstein and Dest Ben/Premalig