SCSC015535 - Judgment against Sac City woman in the amount $789.93.pdf

7/26/2019 SCSC015535 - Judgment against Sac City woman in the amount $789.93.pdf

1/15


2/15

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

SHERRY L.

BAILEY

31 7

LEONARD

ST

SA C

CITY IA 50583

DEFENDANT S)

ORIGINAL NOTICE AND PETITION

FOR A MONEY JUDGMENT

NO.

To Defendant(s):

1. You are notified that the above-named Plaintiff demands o f you the amount of 804.57. Thisclaim is

based on the value of goods and/or services supplied by the following persons or businesses in the amou nts

indicated below. Said claims are assigned to Plaintiff.

CREDITOR

LORING HOSPITAL

PRINCIPAL

789.93

PRE-FILING

INTEREST

14.64

2

Judgm ent may be entered

against

you unlessyo u

file

an

Appearance

an d

Answ er within

20 daysof the

service

of the O riginal No tice upon you. Judgment may include the amount requested plus interest and court

costs.

3.

You m ust electronically file the Appearance and Answer using the Iowa Judicial Branch Electronic

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

the

court an exem ption from electronic filing requirements.

4. Ifyour Appearance

and

Answer

is

filed within

20

days

and you

deny

the

claim,

yo u

will receive

electronicnotificationthroughEDMS of the placeandtimeof thehearingonthis matter

5.

If you

electronically file, EDMS will serve

a

copy

of the

Appearance

and

Answer

on

Plaintiff(s)

or on the

attorney(s)

fo r

Plaintiff(s).

The

Notice

o f

Electronic Filing will indicate

if

Plaintiff(s)

is

(are) exempt from

electronic filing,

and if you

m ust 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 2:31 PM SAC - CLERK OF DISTRICT COURT


3/15

R.NOLLAT0008873

705

Douglas

St. Ste 502

SiouxCityIA51101

Phone 712)224-2675

Fax

712) 252-4497

[email protected]

ATTORNEY FOR PLAINTIFF

956733

OCTOBER

30,

2014



4/15

IN T HE IOWA DISTRICT COURT FOR SAC COUNTY

SMALL CLA IMS DIVISION

L. F.

NOLL INC.

PLAINTIFF

VS

SHERRY L. BAILEY

DEFENDANT(S)

VERIFICATION O F ACCO UNT

IDENTIFICATION OFJUDGMENT

DEBTOR

AN D

CERTIF ICATE

R E

MILITARY SER VICE

NO

For Defendant: SHERRY L. BAILEY

1. I, T. L. Noll, Vice President of L. F.Noll Inc., am a partyorem ployee 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

true

copy

of the

original creditor's records showing

th e

balance

due is

true

and

correct.

I

further state that

the sum

of 804.57 is the balance due and owing as of OCTO BER 30, 2014 from Defendan t(s) to Plaintif f (s) and any

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

2. I further statethat Defendant, SHERRY L.BAILEY,

resides

at 31 7LEONARD ST SAC

CITY

IA

50583.

is

employed

at

LQRING HOSPITAL

21 1HIGHLAND AVE SAC

CITY

IA

50583.

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 S tates governm ent, I have verified this fac

by (check one):

X Checking the Defense Manpow er Data Center (DMDC) (requires name and SSN or name

and

date

of

birth) https://www.dm dc.osd.mil/appi/scra/scraHom e.do.

-

Conta cting Defendant

who

inform ed

me or

. Regularly seeing Defendant and believing De fendant is not active in the U.S.

mil i tary.

OR

B. O I

have

investigated and I amunabletodetermine

whether

or notDefendantis in themilitary

OR

service of the United States governm ent.

C.

O Defendant

is

in the military service of the United States government.

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

Defendant

O is X is no t

under

a

disa bility

or

confined

in any

reform atory, jai l ,

or

penitentiary.

I certify under penalty of perjuryand pursuantto the lawsof the Stateo f Iowa that these facts aretrue and

correct.

L.F. NOLL, INC.

T. L.

NOLL, VICE

PRESIDENT

70 5

Douglas St., Suite

344

Sioux

City,

IA51101

712-252-0583

956733



5/15

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THIS ACCOUNT HAS BEEN LISTED WITH OUR AGENCY FOR

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7/15

NCS,

INCDBA

NOLL COLLECTION SERVICE

AProfessional

Debt Collection Service Since

1965

705

DOUGLAS STREET, SUITE

344

SIOUX CITY,

IA

51101

(712)

252-0583

DATE:

014345

560897 S789.93 01/14/14

The

above debtor refuses

to

cooperate.

We

recommend further action,

in

order toenforce collection. Before our

attorney

ca nproceed, we willrequire:

* Completion of the

assignment

at the bottom of this page.

*Copy of the

itemized

statement showing balance due (if not

previouslyprovided

If the

original account

is a

contract

or

note,

we

must have

the

original.

ASSIGNMENT

EOR

PURPOSES

OF

SUIT

Forvaluable consideration, receipt hereby acknowledged, theundersigned

herebv

assign,transfer,

and set

over unto L.F. Noll, Inc. thatcertain claim against

SHERRYBAILEY

for

goods, wares

and

merchandise sold

and

delivered

or

services rendered

and

performed in theprincipal amount of S789.93

lawful

interest

thereon;

anddoes

hereby authorize said assignee

to do and

perform

all

acts

necessary

for

collection;commencement

of

suit

in the

name of

the

assignee,

settlement

,

adj stment,compromise orsatisfactionofsaid claim.Assignor

hereby certifies that said claim

is

justly

due and

owing

and

warrants

compliancewithrequirements

of the

Iowa

Consumer

Credit Code

as

well

as

disclosure an dother provisions oftruth inlending, andthat same is

free

of

set-offs andother defenses.

THISIS ANATTEMPTTO

COLLECT

ADEBT,

ANY INFORMATION OBTAINED WILL

BE

USED

FOR

THAT PURPOSE



8/15

D O C T O R

GYANO, B . K.

I L L I N DA TE

09/06/13

PAGE

Lor in

Hospital

21 Highland

A ve

Sac

City

IA

50583

; E L E P H O N E

N O

712 660 1995

EX T EN S I ON

M ED R E C N O / A D M I SS I O N N O

22411 / 559148

NO .

I N S U R A N C E C OM PA N Y

POLICY

NUMBER

POLIC Y

HO LDER PLAN

07

05

B L U E

CROSS 140

SELF-PAY

XQH118AD7600

1 4 7 7

BAILEY SHERRY

BAILEY

S H E R R Y

ZTYCLE -0002

G U A R A N T O R

PATIENT NAME

MED.REC NO. /

ADMISSION

NO

SHERRYBAILEY

317 LEONARD ST

SACCITYIA50583

SHERRY

BAILEY

22411

/ 559148

PATIENT

TYPE

32

ADMISSIONDATE

07/18/13

DISCHARGE DATE BIRTHDATE

SEX

AGE

GUARANTOR IS

RESPONSIBLE

FOR ANY

AMOUNTS

DUE

AFTER

THE

INSURANCE

COMPANIES

MAKE THEIR PAYMENTS

D E S C R I P T I O N

ATE

08-06

08-08

08-01

08-06

08-08

08-01

08-06

08-08

08-12

08-15

08-21

08-01

08-12

08-15

08-21

PHYSICALTHERAPY

SUMMARY OF CHARGES

PHYSICAL THERAPY

TOTAL CHARGES

PREV

BALANCE

BALANCE

QUANTITY

C H A R G E

50 00

50 000

60 000

6

60 000

50 000

50 000

50 000

50 000

50 000

50 000

50 000

50 000

50 000

60 000

840

00

840 00

C P T

DEPT TOTAL

P A Y LAST

BALANCE

AMOUNT

50.00

50. 00

60 .00

60 . 00

60. 00

50. 00

50 .00

50 . 00

100.00

50.00

50. 00

50.00

50.00

50 .00

60 . 00

840.00

Moo oo



9/15

O T O R

GYANO , B.

K.

BILL ING DATE

08/06/13 PAGE

Lor i n

Hosp i t a l

K/

21 1 Highland Ave Sac Ci ty IA 50583

TELEPHONE N O

712-660-1995

E X T E N S I O N

MED R E C N O / A D M I

HCS

22411

/ 55914

S

N O

05

I N S U R A N C E C O M PA N Y

SELF-PAY

...~.

V0A9477

POLICY

H O L D E R

-..-- ,

^

BAILEY SHERRY

PL A N

_

wwv

/ <

G U A R A N T O R PAT IENT

NAME

MED R E C N O /A D M I S S IO N NO

SHERRY BAILEY

317LEONARDST

SACCITYIA 50583

SHERRY

BAILEY

22411

/ 559148

PATIENT

T Y P E

32

ADMISSION D A T E

07/18/13

DISCHARGE D A T E

B I R T H D A T E

flV MI 6

SEX AGE

44

G U A R A N T O R I S R E S P O N S I B L E F O R A N Y A M O U N T S D U E A F TE R T H E I N S U RA N C E C O M P A N I E S M A K E T H E I R P A Y M E N T S

D A T E

H R G E

O D E

D E S C R I P T I O N

QUANTITY

C H A R G E

CP T

A M O U N T

07-18

07-22

07-30

07-18

07-22

07-30

07-18

07-30

45 000

45.000

45.000

50 . 00

50

000

50 . 00

120

.

000

50.000

PHYSICALTHERAPY

DEPT

TOTAL

45.00

45 . 00

45.00

50.00

50 . 00

50 . 00

120.00

50.00

455.00

SUMMARY OF CHARGES

PHYSICAL THERAPY

TOTALCHARGES

PREV BALANCE

BALANCE

455

00

455 00

100.00

TtrO

00

P a o . o o



10/15

D O C T O R

BILLING DATE

03 28 14

PAGE

Lorin Hospital

211 Highland Ave Sac City IA 50583

T E L E P H O N E

N O

712 661 8343

EXTENS ION

M E D R E C

S

MO

22411

/

O

INSURANCE COMPANY

BLUE CROSS140

SELF-PAY

POLICYNUMBER

XQH118AD7600

POLICY

HOLDER

BAILEY SHERRY

BAILEY SHERRY

PLAN

UARANTOR

MED. REC.NO. /

ADMISSION

NO

SHERRY BAILEY

317LEONARD

ST

SACCITYIA

50583

SHERRY BAILEY

22411

/

569997

P T I MT

T Y P E

11

A D M I S S I O N D A T E

03 20 14

DISCHARGE DAT E

03/20/14

BJRT HD AT E S EX

AGE

45

G UA R A N T O R I S R E S P O N S I B L E F O R A N Y A M O U N T S DU E A F T E R T HE I N S U RAN CE C O M P A N I E S M A K E T H E I R P AY M E N T S

D A T E

CHARGE

C ODE

D E S C R I P T I O N Q U A N T I T Y

C H A R G E

CRT

AMOUNT

03 20

3 2

3 2

03 20

03 20

3 2

03 20

03 20

03 20

3 2

03 20

EMERGENCYROOM

INFUSION/CHEMO

THE

LABORATORY

PHARMACY

IVSOLUTIONS

OXYGEN

711 000

102.000

54

.000

18.000

36 400

64.520

93.880

44.000

55.000

91.000

169.000

8

.000

99.820

28.350

50.000

DEPTTOTAL

DEPTTOTAL

DEPT TOTAL

DEPT

TOTAL

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

711.00

711.00

102.00

162 .00

264 00

18 .00

36 40

64.52

93.88

44 . 00

55.00

91.00

402 80

169.00

169 00

16.00

99.82

115.82

28.35

28.35

50 00

50.00



11/15

O T O R Lorin

Hospital

PEK Z. L. *

BILLING DATE

\

?br

03/28/14

PAGE

2 21 1 Highland A ve Sac City IA 50583

TELEPHONENO.

EXTENSION

712-661-8343

MED.

REC.NO. / ADMISSION NO.

22411 /

569997

N O. IN S U RA N C E C OM P A N Y P OL IC YN U M B E R . POL ICY HOLDER PLAN

07 BLUE C R O S S 140 XQH118AD7600 BAILEY SHERRY

05 SELF

-PAY 9477 BAILEY

SHERRY

G U A R A N T O R

PATIENT NAME

MED. REC. NO. /

ADM I SSIO N

N O.

SHERRYBAILEY

SHERRY

BAILEY 22411/ 569997

PATIPNT

317

LEONARD

ST TYPE A D M I S S I O N D A T E D I S C H A R G E D A T E B IR T H D AT E , SEX A G E

SAC CITY

IA

50583

11 03/20/14 03/20/14 flMV68 F45

G U A R A N T O R IS R E S P O N S I B L E F O R A N Y A M O U N T S D U EAFTERT H EI N S U R A N C E C O M P A N I E S M A K E T H E I R P A Y M E N T S ^ KJRSH^

D A T E

CHA RG E

C O D E

DESCRIPTION

SUMMARY OF

CHARGES

EMERGENCY ROOM

INFUSION/CHEMO

THERAPY

LABORATORY

EKG

PHARMACY

IV

SOLUTIONS

OXYGEN

TOTAL CHARGES

BALANCE

QUA NTI TY C H A R G E

71100

264 .00

402.80

169.00

115.82

28.35

50.00

1740.97

CR T

AMOUNT

1740

.97

~ < 3 . ( j D

o

-

ID^^



12/15

D O C T O R

BLESSINGTON

KAY

BILLINGDATE

09/10/13

PAGE

Lorin Hospital

3

211Highland

Ave Sac

City

IA

5 583

..^LEPHONE

NO.

712 660 1995

EXTENSION

MED. REC. NO. /Al

22411

/ 560

O.

INSURANCE COMPANY

BLUE CROSS

140

SELF-PAY

POLICY NUMBER

XQH118AD7600

G U R N T O R

POLICY HOLDER

BAILEY SHERRY

BAILEY SHERRY

PLAN

- /


13/15

E-FILED 2014 NOV 26 11:24 AM SAC - CLERK OF DISTRICT COURT


14/15

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 SCSC015535

vs.

JUDGMENT ENTRYDefendant(s),

SHERRY L BAILEY225 12TH STREET APT 2-NVA-SAC CITY IA 50583

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 $ 789.93 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 $14.64.

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: $800.00

1 of 2

E-FILED 2014 DEC 02 10:52 AM SAC - CLERK OF DISTRICT COURT


15/15

State of Iowa Courts

Case Number Case TitleSCSC015535 L F NOLL INC VS SHERRY L. BAILEYType: ORDER FOR JUDGMENT

So Ordered

Electronically signed on 2014-12-02 10:32:54

2 of 2

E-FILED 2014 DEC 02 10:52 AM SAC - CLERK OF DISTRICT COURT

SCSC015535 - Judgment against Sac City woman in the amount $789.93.pdf

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Transcript of SCSC015535 - Judgment against Sac City woman in the amount $789.93.pdf