Bill To:


Hickory County Farmers Mutual Ins. Co.
P.O. Box 132
Hermitage, MO 65668

Services Rendered To:


Jeff Bash
17511 Lilac Road
Lebanon, MO 65536
Policy # 1151229

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-05-309-2021-7-013 07/16/2021 07/23/2021 On Receipt Sleeper V.F.D.

Product
Price
Qty
Amount
  1. 413 Fire Department Response Fee – Lvl 4

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 17511 Lilac Road Lebanon, MO 65536

Subtotal $500.00
Total Due $500.00


Updated
July 23, 2021 @ 4:30 pm

Invoice updated by Geoffrey.

Status Update
July 23, 2021 @ 4:30 pm

Status changed: Draft to Pending.

Updated
January 16, 2022 @ 2:58 pm

Invoice updated by Geoffrey.

Viewed
October 25, 2022 @ 9:42 am

Invoice viewed by 64.124.8.56 for the first time.