Bill To:


STATE FARM INSURANCE
PO BOX 52250
PHOENIX, AZ 85072-2250

Services Rendered To:


Barbara Inman
13357 Hwy E
Eldridge, MO 65463

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-05-307-22-165-E 11/21/2022 05/08/2023 On Receipt Eldridge V.F.D.

Product
Price
Qty
Amount
  1. 405 Medical Extrication – Lvl 1

    Patient

    Michael Inman
    13357 Hwy E
    Eldridge, MO 65463

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy E & Hwy 5- Lebanon, MO

Subtotal $500.00
Total Due $500.00


Updated
May 8, 2023 @ 10:57 am

Invoice updated by Geoffrey.

Viewed
July 22, 2024 @ 3:48 am

Invoice viewed by 69.171.249.1 for the first time.