MARC S. LEMCHEN DMD, PC PATIENT NAME PATIENT N DUE BALANCE 000590 NEW YORK, NY 10065-8108 FOR BILLING INQUIRIES: PAGE: 1 of 1 IIrIIIIIIIIrIIIIIIIrillII 'hill.. 'Ill Ili! 'lir JEFFREY EPSTEIN 301 EAST 66TH ST APT 11P NEW YORK, NY 10065-6217 328951•CAOFAARM200258 590.00 590.00 AGING AMOUNTS: 0-30: 590.00 31-60: 0.00 61-90: 0.00 OVER 90: 0.00 DATE TRANSACTION PATIENT NAME AMOUNT Previcais_Balance: . 0.00 4/6/2015 EXAM/RECORDS/ADULT 495.00 4/7/2015 Radiology Report 95.00 fM . Of, NIL . ID . Al It ti nit i I IF PAYING BY MASTERCARD, DISCOVER, VISA OR AMERICAN EXPRESS, FILL OUT BELOW. PATIENT NAME PAT. At DUE PAID 590.00 P:ease check box if your address b incorrect or I—I has changed, and indicate changeb; on reverse side. owl JEFFREY EPSTEIN NEW YORK, NY 10065-6217 CtIECX CARD USING FOR PAYMENT O MASTERCARD = DISCOVER AMERICAN EXPRESS CARO M.IMBER =NATURE CODE SIGNATURE EXP. DATE STATEMENT DATE 5/1/2015 PAY THIS AMOUNT $590.00 ACCT. It Epstein, Jeffrey 32895 PAGE: 1 of 1 SHOW AMOUNT $ PAID HERE 54108 1501558 32895•TCAOFA4RE00258 IIIM1110111 1 11111 II 111111111 11 EFTA00317363