Bill To:


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

Services Rendered To:


Drake Alexander
5959 E NW Hwy Apt 3056
Dallas, TX 75231
POLICY# 510 490-J13-43A 002
Claim# 43-43S2-56Q


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

    Patient

    Drake Alexander
    5959 E NW Hwy Apt 3056
    Dallas, TX 75231
    POLICY# 510 490-J13-43A 002

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 220 @ CR 545- Erath Co, TX

Subtotal $1,500.00
Total Due $1,500.00


Updated
January 2, 2023 @ 11:39 am

Invoice updated by Geoffrey.

Viewed
February 1, 2023 @ 11:30 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.

Updated
June 6, 2023 @ 3:38 pm

Invoice updated by Geoffrey.