Bill To:

GREAT WEST CASUALTY
1100 WEST 29th STREET
SOUTH SOUIX CITY, NE 68776-3130

Services Rendered To:

J & J Express
P.O. Box 30983
Memphis, AR 38130
Driver: Robert Warren
POLICY # MCP32868A


Product
Price
Qty
Amount

  1. 410 Fire Department Response Fee – Lvl 1

    $350.00
    1
    $350.00

    2. Additional Incident Info

    Incident Type: Fire Department Response

    Incident Location: I-40 Westbound @ MM 247 - Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $350.00
Total Due $350.00
Total Payments Received $350.00
Balance $0.00


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
July 25, 2022 @ 7:05 pm

Invoice updated by Geoffrey.

Status Update
July 25, 2022 @ 7:05 pm

Status changed: Draft to Pending.

Updated
August 12, 2022 @ 6:03 pm

Invoice updated by Geoffrey.

Status Update
November 2, 2022 @ 1:42 pm

Status changed: Pending to Paid.

Payment
November 2, 2022 @ 5:42 pm

Admin Payment
Payment Total: $350.00