Bill To:


STATE FARM INSURANCE
PO BOX 52250
PHOENIX, AZ 85072-2250

Services Rendered To:


Peggy Moore
2090 Kirkland Ave
Russellville, AL 35654
POLICY# 4159252C1901B

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-02-006-24-37-E 02/01/2024 02/08/2024 On Receipt Littleville VFD

Product
Price
Qty
Amount
  1. 405 Medical Extrication – Lvl 1

    Patient

    Peggy Moore
    2090 Kirkland Ave
    Russellville, AL 35654
    POLICY# 4159252C1901B

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: George Wallace Hwy & Lynwood Ave- Russellville, AL

    Ordinance Info: Littleville FD Billing Resolution

Subtotal $500.00
Total Due $500.00


Updated
February 8, 2024 @ 10:14 am

Invoice updated by Geoffrey.