Bill To:

Home State County Mutual Insurance
P.O. Box 8036
Waco, TX 76714-8036

Services Rendered To:

Jerry Meeks
917 E. Beth Street #B
Whitney, Texas 76692
POLICY # PA3265209


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Joana Cornelio

    1514 W. Hammond Street

    Fort Worth, Texas 76115

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 3053 SH 22 - Hillsboro, Texas

    Ordinance Info: Recovery of Service Costs for Peoria VFD

Subtotal $1,500.00
Total Due $1,500.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
September 23, 2022 @ 3:40 pm

Invoice updated by Geoffrey.