Bill To:

Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:

Alton Reilly Stone
140 Sharon Dr
Whitney, TX 76692
POLICY# 23378237


Product
Price
Qty
Amount

  1. 405 Medical Extrication – Lvl 1

    Patient

    Sally Thompson McCommon
    17088 Faircrest Dr
    Whitney, TX 76692
    POLICY# 157 4084-F10-43J 001

    $500.00
    1
    $500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Hwy 22 & Hcr 2421 E- Hillsboro, TX

    Ordinance Info: Recovery of Service Costs for Peoria VFD

Subtotal $500.00
Total Due $500.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
March 28, 2023 @ 3:06 pm

Invoice updated by Geoffrey.