Bill To:


Lutricia Harris
702 Meladon Lane
Mexia, TX 76667

Services Rendered To:


Lutricia Harris
702 Meladon Lane
Mexia, Texas 76667
Policy # 45812237

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-214-2021-24971 10/01/2021 10/08/2021 On Receipt Richland Volunteer Fire Department

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  2. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  3. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 14 Near Southwest County Road 2230 - Richland, Texas

    Ordinance Info: Richland Billing Ordinance NO. 170 Cost Recovery

Subtotal $550.00
Total Due $550.00


Updated
October 7, 2021 @ 9:26 pm

Invoice updated by Geoffrey.

Status Update
October 7, 2021 @ 9:26 pm

Status changed: Draft to Pending.

Updated
September 12, 2022 @ 7:39 pm

Invoice updated by Geoffrey.

Updated
September 12, 2022 @ 7:40 pm

Invoice updated by Geoffrey.

Updated
September 12, 2022 @ 7:41 pm

Invoice updated by Geoffrey.

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