SCSC015514 - Judgment against Schaller woman in the amount $2,474.67.pdf

8/10/2019 SCSC015514 - Judgment against Schaller woman in the amount $2,474.67.pdf

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IN THE IOWA DISTRICT COURT FOR SAC COUNTYSMALL CLAIMS DIVISION

L F. NOLL INC.705 DOUGLAS STREET SUITE 344SIOUX CITY IA 51101

PLAINTIFF

R E B E C C A L HOLBROOKPO BOX 187

208 E 1STSTS C H A L L E R I A 51053DEFENDANT(S)

O R I G I N A L NOTICE A N D PETITIONFOR A MONEY JUDGMENT

O

To Defendant(s):1 You are notified that the above-named Plaintiff demands of you the amount of 2474.67. This claim isbased on the value of goods and/or services supplied by the following persons or businesses in the amountsindicated below. Said claims are assigned to Plaintiff.

CREDITOR PRINCIPALSIOUXLAND OBSTETRICS & GYNECOLOGY, PC 2409.00

PRE-FILING INTEREST 65.67

2 Judgment may be entered against you unless you file an Appearance and Answer within 20 days of theservice of the Original Notice upon you. Judgment may include the amount requested plus interest and courtcosts.

3. You must electronically file the Appearance and Answer using the Iowa Judicial Branch ElectronicDocument Management System (EDMS) at httos://www.iowacourts.state.ia.us/EFile, unless you obtain fromthe court an exemption from electronic filing requirements.

4. If your Appearance an d Answer is filed within 2 0 days and you deny the claim, yo u will receiveelectronic notification through EDMS of the place and time of the hearing on this matter.

5. If you electronically file, EDMS will serve

a copy

of the Appearance

an d Answer

on Plaintiff(s)

or on theattorney(s) for Plaintiff(s). The Notice of Electronic Filing will indicate if Plaintiff(s) is (are) exempt fromelectronic filing, 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 OCT 14 10:03 AM SAC - CLERK OF DISTRICT COURT


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1 S I C A R . NOLL AT0008873 Douglas St., Ste 502

Sioux City IA51101Phone 712) 224 2675Fax 712) [email protected] FOR PLAINTIFF

0002965264OCTOBER 9, 2014



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IN THE IOWA DISTRICT COURT FOR SAC COUNTYSMALL CLAIMS DIVISION

F NOLL INC.PLAINTIFF

MILITARY SERVICEVS

NO

REBECCA L. HOLBROOKDEFENDANT(S)

VERIFICATION OF ACCOUNT

IDENTIFICATION OF JUDGMENTDEBTOR AND CERTIFICATE RE

For Defendant: REBECC A L. HOLBRO OK

1. I, T. L. Noll, Vice President of L, F. Noll, Inc., am a party o r employee of Plaintiff whose claim(s) is (are)shown in the attached statement(s). I have personal knowledge that the attached statement(s) is (are) a truecopy of the original creditor s records showing the balance due is true and correct. I further state that the sum

of 2474.67 is the balance due and owing as of OCTOBER 9, 2014 from Defendant(s) to Plaintiff(s) and anyinterest amount owing is accurately stated in the P etition and O riginal Notice.

2. I further state that Defendant, REB ECC A L. HOLBR OOK . resides at PO BOX 187 208 E 1 ST STSCHALLER IA 51053. is employed at SPARKY S ONE STOP 200 N BER LIN ST SCHALLE R IA 51053, 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 verified this faby (check one):

X Checking the Defense Manpower Data Center (DMDC) (requires name and SSN or nameand date of birth) https://www.dmdc.osd.mil/appi/scra/scraHome.do.

u Contacting Defendant who informed me, or- Regu larly seeing Defendant and believing Defendant is not active in the U.S. military.OR B. O I have investigated, and I am unable to determine whether or not Defendant is in the milita

service of the United States governm ent.OR C. O Defendant is in the military service of the United States government.

4. I also state to the best of my knowledge (check one):Defendant O is X is not under a disability or confined in 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 andcorrect.

L.F. NOLL, INC.

T.^TNOLL/VICE P R E S I E N T705 Douglas St., Suite 344Sioux City, IA 51101712-252-0583

0002965264



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Creditor;

Account :

NTS. I n c .db a N o l l C o l l e c ti o n Service A Prufcssiorial Deb t Collect ion Service Since 1 965

June I S . 2 0 1 4

SIOUXLA ND ODS'i;ETR]CS &

2474. f

S2474 .67

THIS ACCOUNT H A S BEEN LISTED WITH O U R A G E N C Y FO R ]^ COLLECTION

D E A R R E B E C C A L 1 IO L B R O O 1 C ,Y O U A R T : I N D E P 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 SD 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 DN O T D E F A U L T .

Y O U R D E F A U L T C O N S IS T S O F : F A I L U R E T O P A Y A S A G R E E DC 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 N D E F A U LT . S 2 4 74 .6 7 T O N O L LC O L L E C T I O N S E RV I C E . A G E N T F O R T l I E A B O V E C R E D I T O R .I F Y O U D O N O T C O R R E C T T H I S D E F A U L T W I T H I N 3 0 D A Y SW E M A Y E X E R C I S E O U R R I G H T SA 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 T i l lN E X T Y E A RW E M A Y E X E R C I S E O U R R I G H T S W IT H O U TS E N D I N G Y O UA N O T H E R N O T I C E L I K E T H I S O N E . I F Y O U H A V E A N Y Q U E S T I O N S , W R I T E O RT E L E P H O N E P R O M P T L Y.U N L E S S Y O U D I S P U T E T H E VA L I D I T Y O F T H E D E B T O R A N Y P O R T I O N T H E R E O F . W IT H I N 3 0D A Y S A F T E R R E C E I P T O F T H I S N O T I C E . W E S HA L L A S S U M E T H E D E B T T O B E VA L I D . I F Y O UN O T I F Y U S IN W R I T IN G O F Y O U R D I S P U T E W I T H I N T H I S 3 0 D A Y P E R I O D . W E W I L L O B T A I NV E R I F I C AT I O N O F T H E D E B T A N D W IL L M A I L Y O U A C O P Y. U P O N Y O U R W R I T T E N R E Q U E S TW 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 X A D D R E S SO F T H E O R I G I N A L C R E D I T O R I F D 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 I , C O L L E C T I O N S E R V I C EW e o ffe r conven ien t P aymen t Op t ions

M a i l p a y m e n t inenc losed enve lope

P ay o n l i n e :www.ncscol lects .com

C a l l us:( 7 1 2 ) 2 5 2 - 0 5 8 3

THIS IS A N AT T E M P T TO COLLECT A D E B TA N Y I N F O R M AT I O N O B TA I N E D W I L L B E U S E D F O R T H AT P U R P O S E .

M'S. I n c . 7 0 5 [ X H , n i A S S T Rh H , S U I T h U 4 , S I O L X C I I Y 1 A 5 1 1 0 1 . I l l : ( 7 1 2 ) 252-0 -W. T A X . ( 7 1 2 > - 2 . H - .U ( ) 4 . I - m a i l m a i k / .n c s c o l l e c t s turn

PO BO X 593S I O U X C I T Y IA 51 102-0593

Personal Confidential

/ IF PAY I N G a y C R E P I T C A R P. P L E A S E F I L L O U T B E L O W

3 ^ u

0002965264

N C S I N CPO BOX 593SIOUX CITY IA 51102-0593

R l i B l i C C A L H O I . B R O O K208 1 STS C H A l . I . L R , I A 5 1 0 5 3 - 7 7 0 1



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F r o m S i o u x l a n d O b g y n _ 7 1 2 2 7 7 2 6 4 5 0 9 / 3 0 / 2 0 1 4 0 9 : 0 5 2 8 3 P. 0 0 2 / 0 0

NCS, INC DBANOLL COLLECTION SERVICE

A Professional Debt Collection Service Since 1965705 DOUGLAS STREET, SUITE 344

SIOUX CITY, IA 51101(712) 252-0583

DATE: SEPTEMBER 29, 2014

SIOUXLAND OBSTETRICS & 026122GYNECOLOGY PC

2730 PIERCE ST SUITE 201SIOUX CITY, IA 51104

ATTENTION:

RE: REBECCA L HOLBROOK

45017 2409.00 06/16/14

The above debtor refuses to cooperate. We recommend further action, inorder to enforce collection. Before our 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 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, without calling us first.

THANK YOU FOR YOUR COOPERATION

ASSIGNMENT FOR PURPOSES OF SUITFor valuable consideration, receipt hereby acknowledged, the undersigned herebyassign, transfer, and set over unto L.F. Noll, Inc. that certain claim against

REBECCA L HOLBROOK

for goods, wares and merchandise sold and delivered or services rendered andperformed in the principal amount of $2409.00 plus lawful interestthereon; and does hereby authorize said assignee to do and perform all actsnecessary for collection; commencement of suit in the name of the assignee,settlement, adjustment, compromise or satisfaction of said claim. Assignorhereby certifies that said claim is justly due and owing and warrantscompliance with requirements of the Iowa Consumer Credit Code as well asdisclosure and other provisions of truth in lending, and that same is free ofset-offs and other defenses.

Dated. ChiSIOUXLAND OBSTETRICS- &

{Name and

THIS IS AN ATTEMPT TO COLLECT A DEBT,

ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.

0002965264



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nted: 0 6 / 0 4 / 2 0 1 4 1 2 : 5 5 P M

ancial Group: 2-SIOUXLAND OBGYN PC, SIOUX CITY

Guar : 45017

Guar: REBECCA L. HOLBROOKFinClass: PRIVATE PAY

Guarantor Address:

208 EAST 1ST ST

SCHALLER, IA 51053Home: (712) 275-4250

Work: (712) -712

Guarantor Employer: SPARKY'S

T D

SIOUXLAND uBGYN PCACCOUNT DETAIL REPORT

Guar Account Balance:0 - 30 days :

31 to 60 days:

61 to 90 days :

91 to 120 days:121 to 150 daysOver 150 days:

$ 2,409.00 o .OO

$0.00

$0.00

$0.00

$0.00

$2,409.00

Last Statement Date: 02/12/2014

Patient*: 46100 Patient Balance: $2,409.00

Patient: REBECCA L. HOLBROOKPatient Address : Home: (712)275-4250

Work: 712)-

Insurance Balance: $ 0.00 Collection Balance:

208 EAST 1ST ST

SCHALLER, IA 51053 Patient Employer: SPARKY'S

Enc. Date: 12/09/2013 Enc. :Billing Provider: 5-HOLTZ, MD, MELISSA N

66296 Enc. Post Date: 12/12/2013 Loc:Examining Provider: 5-HOLTZ, MD, MELISSA N Referring Provider:

Primary Diagnosisor this Encounter: 12/09/2013

12/09/2013

99998

99998

NO CHARGE P.O.

NO CHARGE P.O.

SIOUXLAND OBSTETRICS

0.00

0.00

PrimaryInsurance Policyfor thisEncounter:

Plan CodePolicy :H o l d e r :Relationship to Holder:Effective Date:

Policy Holder Employer : None

Plan Name :Group *:Group Name :

Expiration Date;

Enc. Date: 01/29/2014 Enc. ff:Billing Provider: 4-ALDRICH, M D ANGELA

69618 Enc. Post Date: 01/30/2014 Loc:

Examining Provider: 4-ALDRICH, MD, ANGELA 3 Referring Provider:

Primary Diagnosisor this Encounter: 01/29/2014 99999 NO CHARGE VISIT

STORM LAKE CLINIC BUEN

0.00

Primary

Insurance Policyfor thisEncounter:

Plan Code

Policy*:Holder :Relationship to Holder:Effective Date:

Policy Holder E m p l o y e r : None

Plan Name :Group :Group Name :

Expiration Date:

Enc. Date: 11/30/2013 Enc. : 67538 Enc. Post Date: 12/26/2013 Loc: MERCY IP MEDICAL CENBilling Provider: 4-ALDRICH, MD, ANGELA J Examining Provider: 4-ALDRICH, MD, ANGELA 3 Referring Provider:

Primary Diagnosisfor this Encounter:

11 3 2 13 58150 2,409.00

only C O O American M edical Association. All Rights reserved.

Dtl.rpt Ve r 8.2.0 Landscape



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rinted: 06/04/2014 12:55 PMUser; MTAYLOR

SIOUXLAND uBGYN PCACCOUNT DETAIL REPORT

Primaryinsurance Policyfor thisEncounter:

Plan CodePolicy :Holder :Relationship to Holder:

Effective Date:

Policy Holder Employer: None


Expiration Date:

Enc Date: 12/18/2013 Enc. :Billing Provider: 4-ALDRICH, MD, ANGELA J

67065 Enc. Post Date: 12/23/2013 Loc:

Examining Provider: 4-ALDRICH, MD, ANGELA J Referring Provider:

Primary Diagnosis or this Encounter: 12 18 2 13 99998 NO CHARGE P.O. 0.0

Primary

Insurance Policyfor thisEncounter:

Plan Code

Policy :Holder :Relationship to Holder:Effective Date:

Policy Holder Employer : None


Expiration Date:

Total Patients:

Total Guarantors:

only 2000 American Medical Association. All Rights reserved.

cctD tl rpt Ver 8 2 0 Landscape



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E-FILED 2014 OCT 27 4:27 PM SAC - CLERK OF DISTRICT COURT


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IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY

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

Case: 02811 SCSC015514

vs.

JUDGMENT ENTRYDefendant(s),

REBECCA L HOLBROOKPO BOX 187SCHALLER IA 51053

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 in

the amount of $ 2474.67 with interest at the rate of 2.11 % from the 14th day of October, 2014 andcourt costs.

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: $2500.00

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E-FILED 2014 NOV 07 3:37 PM SAC - CLERK OF DISTRICT COURT


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State of Iowa CourtsCase Number Case TitleSCSC015514 L.F. NOLL, INC. V HOLBROOK, REBECCA LType: ORDER FOR JUDGMENT

So Ordered

Electronically signed on 2014-11-07 15:37:21

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E-FILED 2014 NOV 07 3:37 PM SAC - CLERK OF DISTRICT COURT

SCSC015514 - Judgment against Schaller woman in the amount $2,474.67.pdf

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