Bill To:

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

Services Rendered To:

Policy# 365 6176-K05-43A 001
Owner: Belinda Morrison
Driver: Brandon Morrison
2279 CR 127
Whitesboro, TX 76273


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient: Brandon Morrison 

    2779 CR 127

    Whitesboro, TX 76273

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: MVA w/Entrapment Response

    Incident Location: FM 371, North of CR 134, Gainesville, TX 76240

Subtotal $1,500.00
Total Due $1,500.00


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
January 17, 2023 @ 2:15 pm

Invoice updated by Karen Smith.