Bill To:


Georgia Farm Bureau
1620 Bass Road
Macon, GA 31209

Services Rendered To:


Al Gabriel
236 Gassert Road
Newborn, GA 30056
Policy # BAP3209265-10

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-811-2021-39-E 08/03/2021 08/23/2021 On Receipt Turkey Heaven V.F.D.

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

    Patient:

    Jessica Kiker
    1087 Boozer Road
    Heflin, AL 36264

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 46 Near County Road 42 - Heflin, AL

Subtotal $1,500.00
Total Due $1,500.00


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