Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Edith Moreno
711 Jefferson Street
Hillsboro, TX 76645
POLICY # 23318616


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

    Patient:

    Joana Cornelio

    1514 W. Hammond Street

    Fort Worth, Texas 76115

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 3053 SH 22 - Hillsboro, Texas

    Ordinance Info: Recovery of Service Costs for Peoria VFD

Subtotal $1,500.00
Total Due $1,500.00


Updated
September 23, 2022 @ 3:42 pm

Invoice updated by Geoffrey.