Bill To:


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

Services Rendered To:


828 Fir Rd
Healdton, OK 73438
Attn: Jerome Abbage

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-10-004-24-37 01/24/2024 02/12/2024 On Receipt Healdton FD

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $400.00
    4
    $1,600.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    4
    $1,000.00
  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  4. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00

  5. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 828 Fir Rd Healdton, OK 73438

Subtotal $2,665.00
Total Due $2,665.00


Updated
February 12, 2024 @ 6:17 pm

Invoice updated by Geoffrey.

Status Update
February 12, 2024 @ 6:17 pm

Status changed: Draft to Pending.

Viewed
July 23, 2024 @ 9:37 pm

Invoice viewed by 69.171.249.115 for the first time.