Field 2: BILLING SERVICE NAME If applicable, enter the name of the billing service that the provider is enrolled. with. If you are not using a billing service, leave this field blank. Field 3: DATE Enter the date the Certification Statement is submitted to the fiscal agent.
Gregory Jerome Coleman (born September 9, 1954 in Jacksonville, Florida) is a retired American football punter who had a 12-year career in the National Football League playing for the Cleveland Browns, the Minnesota Vikings, and the Washington Redskins. He attended Florida A&M University.
Player stats at NFL.com. Leonard Austin Williams (born June 20, 1994) is an American football defensive end for the New York Jets of the National Football League (NFL). He was drafted by the Jets with the sixth pick in the first round of the 2015 NFL Draft. He played college football at USC. 1 Early years.