h Int, 69J FLA Mena 26 Dysa 2.03 52.78 SUS TOTAL 531.96 STATE TAX 6.5002. 34.58 SupLIebItIty 26 °yea 11.95 310.70 BANASIAX JANUSZ TOTAL CMARGES 077.24 358 EL IIRIL10 WAY •*CRWI1$/PATMENIS*• NET DUE 877.24 PATIENTS -877.24 • FL Surchg Incites $2 FL St Srclig 1 .03 Recycle FN Racy CU