Case File
efta-efta01181739DOJ Data Set 9OtherOriginal Receipt. Clerk: ADMIN
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta01181739
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
Original Receipt. Clerk: ADMIN
MT SINAI ASSOCIATES SHIMONY GROUP
(SWPT-012310011009-SHIMONY GROUP
485 MADISON AVE
(
PHONE:
ggr
51.1.10.
Name: JEFFREY
• .
Card Number:
Card Exp Date: XX/XX Card Present
Transaction Type: VISA SALE
Transaction Amount: $1995.00
Auth Code: 05142D
AVS Reply
Ticket #:
Date: 09/27/12 04:45:04 PM
CARDMEMBER ACKNOWLEDGES RECEIPT OF
GOODS AND/OR SERVICES IN THE AMOUNT OF
THE TOTAL SHOWN HEREIN AND AGREES TO
PERFORM THE OBLIGATIONS SET FORTH BY
THE CARDMEMBER's AGREEMENT WITH ISSUER
SIGNATURE
MERCHANT COPY
dailat-eLThcirk.-a C
EFTA01181739
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