Bill To:


Clinton Owen
403 W Lamar St
Richland, TX 76681

Services Rendered To:


Clinton Owens
403 W Lamar St
Richland, TX 76681
POLICY# 29297

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C22-31527-E 12/05/2022 12/16/2022 On Receipt Angus VFD

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Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient

    Pamela Smith
    403 W Lamar St
    Richland, TX 76681

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 221 NB IH-45- Angus, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,500.00
Total Due $1,500.00


Updated
December 16, 2022 @ 1:49 pm

Invoice updated by Geoffrey.

Updated
March 29, 2023 @ 12:44 pm

Invoice updated by Geoffrey.