Bill To:

STATE FARM MUTUAL INSURANCE
ONE STATE FARM PLAZA
BLOOMINGTON, IL 61710-0001

Services Rendered To:

Joseph Allen Epps
State Farm Mutual
POLICY # 536 6039-H07-43 002


Product
Price
Qty
Amount

  1. 405 Medical Extrication – Lvl 1

    Patient:

    Joseph Allen Epps
    State Farm Mutual
    POLICY # 536 6039-H07-43 002

    $500.00
    1
    $500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Crawford Street & Big Indian Road - Gainesville, Texas

Subtotal $500.00
Total Due $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 14, 2022 @ 6:57 pm

Invoice updated by Geoffrey.