scsc015534 - judgment against lake view people in the amount $620.47.pdf

8/10/2019 SCSC015534 - Judgment against Lake View people in the amount $620.47.pdf

1/14


2/14

IN THE IOWA DISTRICT COURT FOR SAC COUNTY

SMALL CLAIMS DIVISION

L.

F. NOLL INC.

705

DOUGLAS STREET SUITE

344

SIOUX CITY

IA

51101

PLAINTIFF

CAROLYN A. CARNES

3230 358TH ST

LAKE VIEW IA 51450

MICHAEL CARNES

3230 358TH ST

LAKE VIEW

IA 51450

DEFENDANT(S)

ORIGINAL NOTICE

AND

PETITION

FOR A MONEY JUDGMENT

O

To

Defendant(s):

1.

You are notified that the above-nam ed Plaintiff demands of you the amount of 637.47. This claim is

based on the value of goods and/or service s supplied by the following persons or businesses in the am ounts

indicated below. Said claims are assign ed to Plaintiff.

CREDITOR

LORING HOSPITAL

PRINCIPAL

620.47

PRE-FILING INTEREST

17.00

2. Judgment may be entered against you unless

yo u

file

an

Appearance

an d

Answer w ithin 20 days

of the

service of the O riginal Notice upon yo u. Judgment may include the amount requested plus interest and court

costs.

3.

You must electronically file the Appearance and Answe r using the Iowa Judicial Branch E lectronic

Document Management System (EDMS) at https://www.iowacourts.state,ia.us/EFile. unless you obtain from

the court an exem ption from electronic filing requ irements.

4. If you r Appearance and Answ er isfiledwithin 20 daysand you deny theclaim,yo uwill receive

electronic notification through EDMS of the place and time of the hearing on this matter.

5. If you electronically file, E DMS will serve a copy of the Appearance and Answer onPlaintiff s)or on the

attorney(s)

for Plaintiff(s). The No tice of Electronic Filingwill indicate ifP laintiff(s) is (are) exempt from

electronicfiling,and if you must mail a copy of your Appearance and Answer to

Plaintiff(s).

6. You must also notify the clerk's office of any address change.

E-FILED 2014 NOV 03 10:48 AM SAC - CLERK OF DISTRICT COURT


3/14

[SSICA R. NOLL AT0008873

705DouglasSt.,Ste 502

Sioux City

IA51101

Phone

712) 224-2675

x 712) 252-4497

[email protected]

ATTORNEY FORPLAINTIFF

965337

OCTOBER 24, 2014



4/14

IN THE IOWA DISTRICT COURT FOR SAC COUNTY

SMALL CLAIMS DIVISION

F NOLL INC.

PLAINTIFF

MILITARY SER VICE

VS

NO.

CAROLYN A. CARNES

MICHAEL CARN ES

DEFENDANT(S)

VERIFICATION OF ACCOUN T

IDENTIFICATION

OF

JUDGMENT

DEBTOR AND CER TIFICATE RE

For Defendant:CAROLYN A. CARNES

1. I, T. L.

Noll, Vice President

of L. F.

Noll, Inc.,

am a

party

or

employee

of

Plaintiff whose claim(s)

is

(are)

shown in the attach ed statem ent(s). I have persona l knowledge that the attached statem ent(s) is (are) a true

copy of the original creditor's records showing the balance due is true and correct. I further state that the sum

of

637.47

is the

balance

due and

owing

as of

OCTOBER

24,

2014 from Defendant(s)

to Plaintiff(s) and any

interest

amount

owing is accurately stated in the Petition and Original Notice.

2. I

further state that Defendant,

C AROLYN A.

CARNES. resides

at

3230 358TH

ST

LAKE VIEW

IA

51450.

is

employed

at , and

Defendant s

occupation is .

3. Check A, B, or C for Defendant:

A. X Defendant is not in the m ilitary service of the United States governm ent, I have verified this fac

by (check one):

X Checking the Defense Ma npower Data Center (DMDC) (requires nam e and SSN or nam e

and date of birth) httDS://www.dmdc.osd.mil/appi/scra/scraHome.do.

n

Contacting Defendantw ho informedm e, or

Regularly seeing Defendant and believing Defendant is not activein the U.S. mil itary.

OR

B. O I have investigated, and I am unable to determine whether or not Defendant is in the m ilitary

service of the United States government.

OR C. O Defendant is in the m ilitary service of the United States governm ent.

4. I also state to the best of m y knowledge (check one):

Defendant O is X is

not

under adisability or confinedin any reformatory,

jail,

or penitentiary.

I certify

under

penalty of perjury and pursuant to the laws of the State of

Iowa

that these facts are true and

correct.

L.F.

NOLL, INC.

T. L. NOLL,

VICE-PRESIDENT

705

DouglasSt.,Suite 344

SiouxC i ty , IA 5 1 1 0 1

712-252-0583

0002965337



5/14

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P A Y I N G

T H E A M O U N T I ND E F A U L T ,

$637.47

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Personal

onfidential

N C S I N C

P O B O X 5 9 3

SIOUXCITY I A 51102-0593

CAROLYN

A N N C A R N H S

MICHAELCARNES

1230

35STHST

LAKE

VIEW,

1A 51450-7436



6/14

KCS, INC DBA

NOLL COLLECTION SERVICE

A Professional

Debt

Collectior.

Service Sinc e 1965

7C5

DOUGLAS STREET,

SUITE 344

SIOUX CITY,

IA

51101

(712] 252-C583

DATE; OCTOBER 13, 2014

LORING

HOSPITAL

014345

ATTN

JAN

WISEMAN

211

HIGHLAND

AVE

SAC

CITY

IA

50533

ATTENTION:

RE: CAROLYN

ANN

CARNES

565157

S620.47

06/17/14

The above debtor refuses

re cooperate.

We recommend further action, in

order

toenforce collection.

Before

ou r

attorney

can

proceed,

we

will

require

*

Completion of the assignment at the

bottom

of

this page.

*

Copy

of the itemized

statement showing balance

due (if not

previously

provided)

* If the original account is a contra ct or note, we must have the

original.

Please

return

promptly.

Court costs

will

be advance d or. your

behalf.

Do

not accept

payments

or make

arrangements,

without calling us

first.

THANK

YOU FOR

YOUR COOPERATION

ASSIGNMENT

FOR

PURPOSES

OF

SUIT

For

valuable

consideration,

receipt hereby acknowledged,

the

undersigned

hereb-

assign, transfer, and set over unto L.F.

Noll,

Inc.

that

certain claim

agair.st

CAROLYN

ANN

CARNES

MICHAEL CARNES

for goods,

wares

and

merchandise sold

and

delivered

or

services rendered

and

performed in the princ ipal amount of $620.4 7 plus lawful interest

thereon;

and

does hereby authorize said assignee

to do and perform ail

acts

necessary

for

collection; commencement

of

suit

in the

name

of the

assignee,

settlement, ad justment,

compromise

or satisfaction of said

claim.

Assignor

hereby certifies

that

said claim is justly due and owing and warrants

ccir.cliar.ee with

requirements

of the

Iowa

Consumer

Credit

Code as well as

disclosure and other

provisions

of truth in lending, and that same is

free of

set-offs and

other

defenses.

Dated this

ck dayof

LORINGHOSPIT L

THIS

IS ANATTEMPT TO

COLLECT

A

DEBT,

ANY

INFORMATION OBTAINED WILL

BE

USED

FOR

THAT

PURPOS



7/14

D O C T O R

LormgHospital |

T E L E P H O N E NO. E X T E N S I O N

MARCZEWSKI

L. J.

y~N 712-660-8526

of i\GDATE \\

M E D . R E C .

N O . / A D M I S S I O N N O .

12/09/13 PAGE 1 J 211

Highland

Ave

Sac

City IA

50583

23621 /

565157

N O

I N S U R A N C E

C O M P A N Y

P O L I C Y

N U M B E R

P O L I C Y H O L D E R

P L A N

0 5 SELF-PAY CARNES CAROLYN

G U A R A N T O R P A T IE N T N A M E MED.

R E C .

N O . / A D M I S S I O N N O .

CAROLYN

A C A R N E S C A R O L Y N A C A R N E S 23621 / 565157

3 2 3 0 358TH STREET P

T Y P

N T A D M I S S I ON D A T E D I S C H A R GE D A T E B I R T H D AT E S E X A G E

LAKE VIEW IA 51450 11 12/01/13

12/01/13

/71 F 42

G U A R A N T O R I S R E S P O N S I B LE

F O R

A N Y A M O U N T S D U E A F T E R T H E I N S U R A N C E C O M P A N I E S

M A K E

TH E I R P A Y M E N T S ^ KWmn^H

D A T E

12-01

12-01

12-01

12-01

C H A R G E

C O D E

D E S C R I P T I O N

EMERGENCY ROOM

INFUSION/CHEMO

THE

PHARMACY

SUMMARY

O F

C H A R G E S

E M E R G E N C Y R O O M

INFUSION/CHEMO

THERAPY

PHARMACY

TOTAL CHARGES

BALANCE

Q U A N T I T Y

1

2

1

1

C H A R G E

308 . 000

51 .000

115.770

94

. 700

308. 00

102.00

210 .47

620 . 47

C R T

DEPT TOTAL

DEPT

TOTAL

DEPT TOTAL

A M O U N T

308.00

308 . 00

102 . 00

102

.00

115.77

94 . 70

210

.47

620.47



8/14

IN

THE IOWADISTRICT COURTFOR SACCOUNTY

SMALL

CLAIMS DIVISION

L. F. NOLL INC

PLAINTIFF

NO.

C A R O L Y N A .

C A R N E S

MICHAEL CARN ES

DEFENDANT(S)

VERIFICATION OF ACC OUNT

IDENTIFICATION OF JUDGMENT

DEBTOR

AND

CERTIFICATE

R E

MILITARY SERVICE

For Defendant: MICHAEL CA RNE S

1. I,

T. L.

Noll, Vice President

of L. F.

Noll, Inc.,

am a

party

or

employee

of

Plaintiff whose ctai m(s)

is

(are)

shown in the attached statement(s). I have personal knowledge that the attached statement(s) is (are) a true

copy

of the

original

creditor's records showing the balance due is true and correct. I further state that the sum

of 637.47

is the

balance

due and

owing

as of

OCTOBER

24 ,

2014 from Defendant(s)

to

Plaintiff(s)

and any

interest amount owing is accurately stated in the Petition and Original Notice.

2.

I

further

state that Defendant MICHAEL CARNES. residesat

3230

358TH STLAKEVIEWIA 51450. is

employed at

DENNY'S SHELL 3001

HW Y 71

LAKE VIEW

IA

51450,

and

Defendant's occupation

is

3.

Check

A,

B, or C for Defendant:

A. X Defendant is not in the military service of the United States government, I have verif ied this fact

by

(check one):

X

Checking the Defense Manpower Da ta Center (DMDC)

{requires

name and SSN or name

and

date

of

birth) https://www.dmdc.osd.mil/appi/scra/scraHome.do.

Contacting Defendant who informed me, or

Regularly seeing Defendant

and

believing Defendant

is not

active

in the

U.S. m il itary.

OR B. O I have investigated, and I amunable to determine whether or not Defendant is in the military

service

of the United States governm ent.

OR C. O

Defendant is

in the

military service

of the

United States government.

4.

I also sta te to the best of my knowledge (check one):

Defendant

O is X is notunder adisa bilityorconfined in any reformatory, ail , or penitentiary.

I certify under penalty of perjury and pursuant to the laws of the State of Iowa that these facts aretrue and

correct.

LF.NOLL

INC

T.

L.NOLL VICE-PRESIDENT

70 5

Douglas St., Suite 344

Sioux

City, I A 5 1 1 0 1

712-252-0583

0002965337



9/14

IS.CS.I n c .

dba Nol l C ol l ec t ion Service

"A

P r o f e s s i o n a l

Dchl

C ol l ec t ion Se rv i ce S ince

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LORING110SPITAL

S637.47

J u n e

2 0 , 2 0 1 4

THIS ACCOUNT HAS BEEN LISTED WITH O UR A G E N C Y F O R

]

COLLECTION.

D E A R CAROLYN A N NCARNES M I C H A E L CARNES,

Y O U A R E I N D E F A U L T O N

T H I S

C R E D I T T R A N S A C T I O N . Y O U H A V E A R I G H T T O C O R R E C T T H I S

D E F A U L T . I F Y O U D O S O ,

Y O U '

M A Y C O N T I N U E

W I T H

T H E C O N T R A C T A S T H O U G H Y O U D I D

NOT D E F A U L T .

Y O U R D E F A U L T C 'O N S I S T S OF: F A I L U R ETO PAY ASA G R E E D

C O R R E C T T H I S D E F A U L T B Y : P A Y I N G T H E A M O U N T I ND E F A U L T ,S637.47 T O N O L L

C O L L E C T I O N S E R V I C E . AGENT

FOR THE

ABOVE C R E D I T O R .

IF

YOU DO NOTC O R R E C T T H I S DE F A U L T W I T H I N30D A Y S , WE MAY E X E R C I S EOUR R I G H T S

A G A I N S T

Y O U U N D E R T H E L A W .

I F

Y O U " D E F A U L T

A G A I N W I T H I N

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N E X T Y E A R ,

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P E R I O D , W :E W I L L O B T A I N

V E R I F I C A T I O N O F T H E D E B I A N D W I L L M A I L Y O U ACOPY. U P O N Y O U R W R I T T E N

REQUEST

W I T H I N A T H I R T Y D A Y P E R I O D W E W I L L P R O V I D E Y O U W I T H T H E N A M E A N D A N A D D R E S S

O F T H E O R I G I N A L

C R E D I T O R

I KD I F F E R E N T F R O M T H E C U R R E N T

C R E D I T O R .

S I N C E R E L Y ,

N O L L COLLECTION S E R V I C E

We

o ffer convenient Payment

Options

M a i l p a y m e n t in

enc losed

e n v e l o p e

P a y o n l i n e :

www.ncsco l lec ts . eom

C a l l

u s:

( 7 1 2 )252-0583

T H I S

IS

AN TTEMPT

TOCOLLECT

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S I O U X C I T Y 1A5 1 1 0 2 - 0 5 9 3



10/14

NCS, INC DBA

NOLL COLLECTION

SERVICE

A

Professional

Debt

Collection

Service Since 1965

7C5

DOUGLAS STREET, SUITE 344

SIOUX CITY, IA

51101

(712)

252-0583

DATS: OCTOBER 13,

2014

LORING

HOSPITAL

C14345

ATTN

JAN

WISEMAN

211 HIGHLAND AVE

SAC CITY IA

50583

ATTENTION;

RE: CAROLYN

ANN

CARNES

565157 $620.47

06/17/1.4

The above debtor refuses to

cooperate.

We recommend further action,

ir.

order to

enforce

collection. Before our attorney canproceed, we will require

*

Completion of the

assignment

at the bottom of this page.

*

Copy of the itemized statement showing balance due (if not

previously provided)

* If the original account

is

a contract or note, we must have the

original.

Please return promptly. Court costs

will

be advanced on your behalf.

Do not

accept

payments or make

arrangements,

wi tho ut calling us first.

THANKYOU FORYOUR COOPERATION

ASSIGNMENT

FOR

PURPOSES

OE

SUIT

For

valuable

consideration,

receipt hereby acknowledged,

the

undersigned hereby

assign, transfer, and set over

unto

L.F. Noil, Inc. that certain claim against

CAROLYN ANN CARNES

MICHAEL CARNES

for

goods,

wares and merchandise sold and

delivered

or servicesrenderedand

performed in the principal amount

of 5620.47

plus lawful interest

thereon;

and

does hereby authorize said assignee

to do and

perform

all

acts

necessary for col lec tio n; commencement of suit in the name of the assignee,

settlement,

adj

ustmerit,

compromise or satisfaction of said claim. Assignor

hereby certifies

that

said

claim

is justly due and owing and warrants

compliance with

recuiremerits

of the Iowa Consumer Creait Code as

well

as

disclosure

and other provisions of truth in lending, and that same is free of

set-offs

and othe r defenses.

.lAx

, 20

and

Official Title

By

:

THIS IS AN ATTEMPT TO

COLLECT

A DEBT,

ANY INFORMATION OBTAINED WILL BE USED

FOR

THAT PURPOSE



11/14

D O C T O R LOnn^MOSpltal |

T E L E P H O N E

N O

E X T E N S I O N

MARCZEWSKI L. J.

^a

712 660 8526

BILLINGDATE \\\

MED.

REC.

NO.

/ADMISSION

NO.

12/09/13

PAGE

1 J 211HighlandAve SacCity IA5 583

23621

/

565157

NO. INSURANCECOMPANY POLICY NUMBER P O L I CY HO L DE R PLAN

05 SELF-PAY

CARNES

CAROLYN

G U A R A N T O R

PATIENT

NAME MED. REC.N O /ADMISSION N O

CAROLYN CAROLYN

A

CARNES 23621

/

565157

3230

358

TH STREET

^ T Y P E * '1 ADM ISSIO N DATE DISCHARG E DATE B IRTHDATE

S E X A G E

LAKE

VIEW

IA

51450

11

12/01/13 12/01/13 /71

F 42

G U A R A N T O R IS RESPONSIBLEFOR ANY A M O U N T S DU EAFTER TH E INSURANCE COM PANIES MAKE THEIR PAYMEN TS

DATE

12 01

12 01

12 01

12 01

CHARGE

CODE

DESCRIPTION

EMERGENCY ROOM

INFUSION/CHEMO

THE

PHARMACY

SUMMARY OF CHARGES

EMERGENCY

ROOM

INFUSION/CHEMO

THERAPY

PHARMACY

TOTAL CHARGES

BALANCE

Q U A N T I T Y

1

2

CHARGE

308 00 0

51 . 000

115 .

770

94

. 700

308 . 00

102

00

210.47

620.47

CR T

DEPT

TOTAL

DEPT TOTAL

DEPT TOTAL

PA YLAST 1

BALANCE

A M O U N T

308

. 00

308

.00

102 . 00

102 . 00

115.77

94 .70

210 . 47

620

.47



12/14



13/14

IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY

Plaintiff(s), SMALL CLAIMS DIVISIONL F NOLL INCPO BOX 593SIOUX CITY IA 51102

Case: 02811 SCSC015534

vs.

JUDGMENT ENTRYDefendant(s),

MICHAEL PAUL CARNES3230 358TH STREETLAKE VIEW IA 51450

CAROLYN CARNES3230 358TH STREETLAKE VIEW IA 51450

The court file shows that the defendant has received proper notice and has failed to answer. Therelief is readily ascertainable from the Original Notice. Pursuant to Iowa Code Section 631.5(6), thedefendant is in default and judgment should enter accordingly.

It is therefore Ordered that judgment is entered in favor of the plaintiff and against the defendant inthe amount of $ 620.47 with interest at the rate of 2.10 % from the 3rd day of November, 2014 andcourt costs.The Court further enters judgment for prejudgment interest in the amount of $17.00.

YOU ARE HEREBY NOTIFIED that you have a right to appeal the decision to the District Court bygiving written notice to the Small Claims Office within 20 days of the filing of this order. Filing Fee forappeal is $185.00. Appeal Bond is set in the amount of: $650.00

1 of 2

E-FILED 2014 DEC 02 10:23 AM SAC - CLERK OF DISTRICT COURT


14/14

State of Iowa Courts

Case Number Case TitleSCSC015534 L F NOLL INC VS CAROLYN A. AND MICHAEL CARNESType: ORDER FOR JUDGMENT

So Ordered

Electronically signed on 2014-12-02 10:19:36

2 of 2

E-FILED 2014 DEC 02 10:23 AM SAC - CLERK OF DISTRICT COURT

scsc015534 - judgment against lake view people in the amount $620.47.pdf

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