Bill To:


Rojas Jr Cipriano
1903 N Guadalupe St
Seguin, TX 78155

Services Rendered To:


Rojas Jr Cipriano
1903 N Guadalupe St
Seguin, TX 78155
POLICY# 960465938

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HS-403-22-452-E 11/20/2022 11/25/2022 On Receipt McQueeney VFD

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

    Patient

    Rojas Jr Cipriano
    1903 N Guadalupe St
    Seguin, TX 78155
    POLICY# 960465938

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 7499 Fm 1044- McQueeney, TX

    Ordinance Info: RESOLUTION-McQueeney Cost Recovery Resolution 4521

Subtotal $1,500.00
Total Due $1,500.00


Updated
November 25, 2022 @ 11:19 am

Invoice updated by Geoffrey.

Updated
March 15, 2023 @ 11:18 am

Invoice updated by Geoffrey.