JUL-26-2002 14:01 FROM:DR.MAGNANI TO:16467067223 P.1'l Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West Slat Street 7th Floor New York NY 10019 Jeff Epstein P.O. Box808 New York NY 10160 HISTORICAL STATEMENT 7/18/2013 to 7/25/2013 (Jeff] Tolephono: Date Account 7/25/2013 3114 Date Patient Description Charges Credits Balance 7/18/2013 7/18/2013 Jeff Jeff Recall Oral Exam Adult Scale & Prophy 40.00 180.00 40.00 220.00 Account Total 220.00 Patient Charges 220.00 Patient Payments 0.00 Patient Credits 0.00 Patient Debits 0.00 Current 30 Days 60 Delia 90 Days 120+ Days Thomas J. Magnanl Alv;n Grayson D.D.S. 7 West 51st St. at th Floor New York NV 10019 EFTA00283636