judgment against lake view couple in the amount $1,065.16

8/13/2019 Judgment Against Lake View Couple in the Amount $1,065.16

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2/16

INTHE IOWADISTRICTCOURTFOR SAC COUNTYSMALLCLAIMS DIVISION

L. F.NOLL INC.705DOUGLASSTREET SUITE344SIOUX CITY IA 51101PLAINTIFFVS

LARRYG.BLEVINS351 S STATER DPO BOX 284LAKEVIEW IA 51450-0284KELSEY BLEVINS351 SSTATERDPO BOX 84LAKEVIEW IA 51450-0284DEFENDANT(S)

ORIGINAL NOTICE ANDPETITIONFOR AMONEYJUDGMENT

NO.

To Defendant(s):1. You arenotifiedthattheabove-named Plaintiff demandsof you theamountof 1066.08. This claim isbasedon thevalueo fgoods and/or servicessuppliedby thefollowing personsorbusinesses in theamountsindicated below. Said claimsareassignedto Plaintiff.CREDITORLORINGHOSPITALMARIE C.G'SELL,DOSTOTAL

PRINCIPAL 36.88$1028.28 1065.16PREFILING INTEREST .92 0.00 .92

2. Judgmentmay beenteredagainstyou unless youfilean AppearanceandAnswer within 20 daysof theservice of theOriginal Notice upon you. Judgment may include the amount requested plus interest andcourtcosts3. You must electronically filetheAppearanceandAnswer usingtheIowaJudicialBranch ElectronicDocumentManagement System (EDMS)athttps://www.iowacourts.state.ia.us/EFile.unlessyouobtain fromthecourt anexemptionfromelectronicfilingrequirements.4. Ifyour AppearanceandAnswer isfiled within 20 daysand youdenythe claim, youwill receiveelectronicnotification through EDMSof theplaceandtimeof thehearingonthismatter.5. If youelectronicallyfile,EDMSwit serveacopyof theAppearanceandAnsweron Plaintiff(s)or on theattorney(s)for Plaintiff(s). The NoticeofElectronicFilingwill indicate ifPlaintiffs) is(are) exempt fromelectronic filing,and if youmust mailacopyo fyour Appearanceand AnswertoPlaintiff(s).6. Youmust also notifythe clerk's officeof anyaddress change.

E-FILED 2013 NOV 13 4:31 PM SAC - CLERK OF DISTRICT COURT


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R. NOLL AT0008873705Douglas St.,Ste 502Sioux City IA 51101Phone 712) 224-2675Fax 712) [email protected] PLAINTIFF 294 746NOVEMBER 7 2013



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INTHEIOWADISTRICT COURTFOR SAC COUNTYSMALL CLAIMSDIVISION

L. F.NOLL,INCPLAINTIFFVS

L RRYG BLEVINSKELSEY BLEVINSDEFENDANT(S)

VERIFIC TION OFACCOUNTIDENTIFICATION OF JUDGMENTDEBTORANDCERTIFICATE RE

MILIT RY SERVICENO

For Defendant: LARRYG BLEVINS

1. I,T. L.Noll, Vice Presidentof L, F.Noll,Inc.,am apartyoremployeeofPlaintiffwhoseclaim(s)is(are)shownin the attached statement(s). I have personal knowledge that the attached statement(s) is (are) a trucopyof the originalcreditor's records showingthebalancedue istrueandcorrect. Ifurther statethatthe suof 1066.08is thebalancedue andowingas ofNOVEMBER7,2013 from Defendant(s) toPlaintiff(s)and ainterestamount owingisaccurately statedin thePetitionandOriginal Notice.2. I further state that Defendant, LARRY G. BLEVINS. resides at 351 S STATE RD PO BOX 284 LAKEVIElA51450-0284.isemployedatPROLIANTHWY 20 MAINSTLYTTONIA50561.andDefendant'soccupationis .3. CheckA, B, or C for Defendant:A. X Defendantis notin the militaryserviceof the UnitedStates government, haveverified thisfby(check one):

X Checking the Defense Manpower Data Center (DMDC) (requires name and SSN or nameanddateofbirth)https://www.dmdc.osd.mil/appj/scra/scraHome.do.a Contacting Defendantw hoinformedm e, ora Regularly seeing DefendantandbelievingDefendantis notactivein theU.S. military.OR B. O Ihave investigated,and amunabletodetermine whetheror notDefendant is in themilitaryservice of the United States government.OR C. O Defendantisin themilitaryserviceof theUnitedStatesgovernment.4. Ialso stateto thebestof myknowledge (check one):Defendant O is X isnotunderadisabilityor confined in anyreformatory,jail,orpenitentiary.Icertify under penaltyofperjuryandpursuantto thelawsof theStateofIowa that these facts aretrueandcorrect.

L.F. NOLL, INC.

T.L NOLbf^iCEPRESIDENT705DouglasSt.,Suite34 4Sioux City,IA51101712-252-0583 294 746



5/16

IN THEIOWA DISTRICT COURTFOR SACCOUNTYSMALLCLAIMS DIVISIONF NOLL INCPLAINTIFF

VSLARRYG BLEVINSKELSEY BLEVINSDEFENDANT(S)

VERIFICATIONOF ACCOUNTIDENTIFICATION OFJUDGMENTDEBTORANDCERTIFICATEREMILITARYSERVICENO

ForDefendant: KELSEYBLEVINS

1. I T. L.Noll, Vice Presidentof L. F.Noll,Inc.,am apartyoremployeeofPlaintiff whose claim(s) is(are)shownin 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 sumof 1066.08is the balance due and owing as of NOVEMBER7 2013 from Defendant(s) toPlaintiff(s)and aninterest amount owingisaccurately statedin thePetitionandOriginal Notice.2. I further state that Defendant, KELSEY BLEVINS. resides at351 S STATE RD PO BOX 284 LAKE VIEW I51450-0284.isemployedat , andDefendant's occupationis .3. CheckA B or C for Defendant:A. X Defendantis notin themilitaryservice of theUnited Statesgovernment, I haveverifiedthisfacby(check one):X Checking the Defense Manpower Data Center (DMDC) (requires name and SSN or name

anddateofbirth)httPs://www.dmdc.osd.mii/appi/scra/scraHorne.do.n Contacting Defendantwhoinformed me, ora Regularly seeing Defendant and believing Defendant is not active in the U.S. military,haveinvestigated,and I am unable todeterminewhether or notDefendantis in themilitaryR B. O Iserviceof theUnited States government.OR C. O Defendantis in themilitary serviceof theUnited States government.

4. I also state to the best of my knowledge (check one):Defendant O is X is notunderadisabilityorconfinedin anyreformatory,jail, orpenitentiary.Icertify under penaltyofperjuryandpursuantto thelawsof theStateofIowa that these factsaretrueandcorrect.

T. L. NOLL, VICE PRESIDENT705DouglasSt.,Suite 344SiouxCity,IA51101712-252-0583 294 746



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NCS, INC DBANOLL COLLECTION SERVICE

A ProfessionalDebt CollectionService Since1965705 DOUGLAS STREETSUITE 344

SIOUX CITY IOWA 51101(712) 252-0583

FAX (712) 233-3404FEBRUARY21, 2013LARRY G BLEVIN S KELSEY BLEVINSPO BOX 284LAKEVIEW IA514500284

CREDITOR: LISTED BELOW IFMORE THAN ONELORING HOSPITALACCOUNT NO.0002927509TOTAL AMOU NT DUE: $37.80AMOUNT IN DEFAULT: $37.80

YOU ARE IN DEFAULT ON THISCREDITTRANSACTION. YOUHAVEARIGHTTOCORRECTTHIS DEFAULT. IF YOU DO SO, YOU MAY CONTINUE WITH THE CONTRACT AS THOUGH YOUDIDNO TDEFAULT.YOUR DEFAULT CONSISTS OF: FAILURETO PAY AS AGREEDCORRECT THIS DEFAULT BY: PAYING THE AMOUNT IN DEFAULT, $37.80 TONOLL COLLECTION SERVICE, AGENT FOR THE ABOVE CREDITOR .IFYOU DO NOTCORRECTTHISDEFAULT WITHIN 30DAYS,WE MAY EXERCISE OURRIGHTSAGAINST YOU UNDER THELAW.IFYOU DEFAULT AGAIN WITHIN THENEXT YEAR,WE MAY EXERCISEOURRIGHTS WITHOUTSENDING YOU ANOTHER NOTICE LIKE THIS ONE. IF YOU HAVE ANY QUESTIONS, WRITE ORTELEPHONEPROMPTLY.

SINCERELY,

NOLL COLLECTION SERVICEUNLESS YOU DISPUTE THE VALIDITY OF THE DEBT OR ANY PORTION T HEREOF, WITHIN 30DAYS AFTE R RECEIPT OF THIS NOTICE, WE SHALL ASSUME THE DEBT TO BE VALID. IFYOUNOTIFY US IN WRITING OF YOUR DISPUTE WITHIN THIS 30 DAYPERIOD, WEWILLOBTAIN VERIFICATIONOF THEDEBTANDWILL MAILYOU A COPY. UPON YOUR WRIT TENREQUEST WITHIN A TH IRTY DAY PERIOD WE WILL PROVIDE YOU WITH THE NAME AND ANADDRESS OF THE ORIGINAL CREDITOR IF DIFFERENT FROM THE CURRENT CREDITOR.

THIS IS AN ATTEMPT TO COLLECT A DEBTANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE

/CLIENT PRINCIPAL INTEREST OTHER TOTALLORING HOSPITAL $36.88 $0.92 $0.00 $37.80



7/16

NCS,INC DBANOLLCOLLECTION SERVICE

AProfessional Debt Collection Service Since1965705DOUGLAS STREET, SUITE 344

SIOUX CITY, IA 51101(712) 252-0583

DATE:OCTOBER21,2013LORING HOSPITAL 014345ATTN JAN WISEMAN211HIGHLANDAVESACCITYIA 50583ATTENTION:RE LARRYGBLEVINS

543691 $36.88 02/19/13Theabove debtor refusestocooperate.Werecommend furtheraction, inorder toenforce collection. Beforeourattorneycanproceed,wewill require

* Completion of theassignmentat the bottom ofthispage,*Copyof theitemized statement showing balancedue (if notpreviously provided)* If theoriginal accountis acontractornote,wemust havetheoriginal.

Please returnpromptly. Court costs willbeadvancedonyourbehalf.Donot accept payments or make arrangements, without calling us first.

THANKYOU FORYOUR COOPERATION

ASSIGNMENTFORPURPOSESOFSUITForvaluable consideration, receipt hereby acknowledged,theundersigned herebyassign,transfer,and setover unto L.F. Noll, Inc. that certain claim against

LARRYG BLEVINSKELSEYBLEVINS

forgoods, waresandmerchandise soldanddeliveredorservices renderedandperformedin theprincipalamountof$36.88 pluslawful interestthereon; anddoes hereby authorize said assigneeto do andperformallactsnecessaryforcollection; commencementofsuitin thenameof theassignee,settlement,adjustment, compromiseorsatisfactionofsaidclaim.Assignorherebycertifies that saidclaimisjustlydue andowingandwarrantscompliancewith requirements of the Iowa Consumer Credit Code as well asdisclosureandother provisionsoftruthinlending,andthat sameisfreeofset-offsandotherdefenses.Datedthisps dayoffcj>MA_. 2LORINGHOSPITAL

(NameandOfficialTitle)THIS IS AN ATTEMPT TO COLLECT A DEBT,

ANYINFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.0002927509



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DOCTORM A R C Z E W S K I L. J.

BILLING DATE08/01/12 PAGE

italc^2 HighlandA ve Sac City IA 5 583

TELEPHONE NO7 2 6S7 2563

EXTENSION

MED REC NO /ADMISSIONNO24994 / 543691

NO INSURANCECOMPANY POLICY NUM ER POLICY HOLDER PLAN

07

BLUECROSS 140SELF-PAY

MJP322AD0036481068468

BLEVINS LARRYBLEVINS LARRY

GUARANTOR PATIENTNAME MED REC O / DMI S S I O N N OL A R R Y G BLEVINSPO BOX 284L A K E VI E W IA 51450

LARRYGBLEVINS 24994/ 543691PTYPET

11ADMISSIONDATE07/26/12

DISCHARGE DATE07/26/12

BIRTHDATE1/84

SEX

MAGE 7

GUARANTOR IS RESPONSIBLE FOR ANY AMOUNTS DUEAFTERTHEINSURANCE COMPANIESMAKE THEIR PAYMENTS

DATE DESCRIPTION QUANTITY CHARGE CPT

PAY LASTBALANCFAMOUNT

07 2607 26

07 26

3100002 L E V E L 1E M E R G E N C Y R O O M

PHARMACY

231183 62

82.990

DEPTTOTAL

DEPT TOTAL

231.00183.62414.62

82 9982 99

SUMMARY OF CHARGESEMERGENCY ROOMPHARMACYTOTALCHARGES

B A L A N C E

414 6282 99

497 61

497.61



9/16

NCS, INC DBANOLLCOLLECTION SERVICE

A Professional Debt Collection Service Since1965705 DOUGLAS STREETSUITE 344

SIOUX CITY IOWA 51101(712) 252-0583

FAX (712)233-3404NOVEMBER 7, 2013

LARRYGBLEVINS KELSEY BLEVINS351 S STATE RDPO BOX 284LAKE VIEW IA 514500284CREDITOR: LISTED BELOW IF MORE THAN ONE

MARIE CG'SELL, DDSACCOUNTNO.0002939504TOTAL AMOUNT DUE: $1028.28AMOUNT INDEFAULT: $1028.28

YOU ARE IN DEFAULT ON THIS CREDIT TRANSACTION. YOU HAVE A RIGHT TO CORRECTTHIS DEFAULT. IF YOU DO SO, YOU MAY CONTINUE WITH THE CONTRACT AS THOUGH YOUDIDNOT DEFAULT.YOURDEFAULT CONSISTSOF: FAILURE TO PAY AS AGREEDCORRECT THIS DEFAULT BY: PAYING THEAMOUNT INDEFAULT,$1028.28TONOLLCOLLECTIONSERVICE, AGENT FOR THE ABOVE CREDITOR.IFYOU DO NOT CORRECT THIS DEFAULT WITHIN 30DAYS,WE MAY EXERCISE OUR RIGHTSAGAINST YOU UNDER THELAW.IF YOU DEFAULT AGAIN WI THI N THE NEXT YEAR, WE MAY EXERCISE OUR RIGHTS WITHOUTSENDING YOU ANOTHER NOTICE LIKE THISONE. IF YOU HAVE ANY QUESTIONS, WRITE ORTELEPHONE PROMPTLY.

SINCERELY,NOLL COLLECTION SERVICEUNLESSYOUDISPUTETHEVALIDITYOF THE DEBT OR ANY PORTION THEREOF, WITHIN 30DAYSAFTER RECEIPT OF THIS NOTICE, WE SHALL ASSUME THE DEBT TO BE VALID. IFYOUNOTIFY US INWRITINGOF YOUR DISPUTE WITHIN THIS 30 DAY PERIOD,WE WILLOBTAIN VERIFICATION OF THE DEBT AND WILL MAIL YOU ACOPY. UPON YOUR WRITTENREQUESTWITHIN A THIRTY DAY PERIOD WE WILL PROVIDE YOU WITH THE NAME AND ANADDRESS OF THE ORIGINAL CREDITOR IF DIFFERENT FROM THE CURRENT CREDITOR.

THIS IS AN ATTEMPT TOCOLLECT A DEBTANY INFORMATION OBTAINEDWILLBE USED FORTHAT PURPOSE

/CLIENT PRINCIPAL INTEREST OTHER TOTALMARIECG'SELL,DDS $1028.28 $0.00 $0.00 $1028.28



10/16

NCS,INC DBANOLL COLLECTIONSERVICE

A.Professional Debt Collection Service Since 1965705DOUGLAS STREET, SUITE344SIOUXCITY,IA 51101

(712)252-0583DATE:OCTOBER21,2013MARIEC G'SELL,DOS 0157971406N US HWY 71CAROLL, IA 51401ATTENTION:RE:LARRYGBLEVINS

BL0035 1028.28 08/08/13Theabove debtor refusesto coopera-t-e.- We recoinmend further-action-,in------order toenforce collection. Before ou r attorneyc an proceed,we will require:

*Completion of the assignmentat the bottomof this page.*Copyof the itemized statement showing balancedue (if notpreviously provided)* If theoriginal account is a contract or note,we must havetheoriginal.

Please return promptly. Court costs willbeadvancedonyourbehalf.Donotaccept paymentsormakearrangements,without callingusfirst.

THANK YOU FOR.YOURCOOPERATION

ASSIGNMENT FORPURPOSESOFSUITForvaluable consideration, receipt hereby acknowledged,the undersigned herebyassign,transfer,and set over unto L.F. Noll, Inc. thatcertain claim againstLARRYGBLEVINSKELSEY BLEVINSfor goods, wares and merchandise soldand deliveredor services rendered andperformed in theprincipal amount of $1028.28 plus lawful interestthereon;and does hereby authorize said assigneeto do and perform all actsnecessary for collection; commencement of suitin the nameof the assignee,settlement,adjustment, compromise or satisfaction of said claim.Assignorherebycertifies that said claimisjustlydue and owing and warrantscompliance with requirementsof the Iowa Consumer Credit Code aswellasdisclosure and other provisionsof truthin lending,and that sameis freeofset-offs a ndother defenses.Datedthis dayofMARIECG'SELL,DDS

C(NameandOfficialTitle)THISIS AN ATTEMPT TOCOLLECTADEBT,A NYINFORMATION OBTAINED WILLBEUSEDFORTHATPURPOSE.

0002939504



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SINGLEP TIENTLEDGERC RROLL DENT L SSOCI TES

07/19/2013PatientName: Larry GBlevins351 S State Rd

POBox 284Lake View, IA 51450

ChartNumber:BL0035

BillingType: 1

Page: 1

DATE TEETH DESCRIPTION PATIENT2 Patient Balance Forward2

3/201 2 10 11 12 18 18

192 19 LL Dental InsPayment 14 1512 20 21

DentalInsPayment07/2013 Dental Ins Payment07/2013 Dental Ins Payment27/2013 Finance Charge24/2013 Finance Charge23/2013 Finance Charge

LarryLarryLarryLarryLarryLarryLarryLarryLarryLarryLarry

_ _ _ _ Larry- Delta Dental of Iowa LarryLarry

LarryLarryLarry

- DeltaDentalofIowa Larry-Delta Dentalof Iowa Larry- Delta Dental of Iowa LarryLarry

LarryLarry

TOTAL PATIENTBALANCE AS OF

CHARGE PAYMENT0.00

50.00115.00150.00185.00195.00118.00184.0085.0085.0085.0085.00184.00

-165.0085.00

130.00130.00118.00 -247.04

-364.00-223.96

14.7614.7614.76

07/19/2013:

BALANCE0.00

50.00165.00315.00500.00695.00813.00997.00

1082.001167.001252.001337.001521.001356.01441.001571.001701.001819.001571.91207.96984.00998.7

1013.51028.2

1028.28

beenplaced inHistory.



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E-FILED 2013 DEC 16 1:11 PM SAC - CLERK OF DISTRICT COURT


13/16



14/16



15/16

IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY

Plaintiff(s), SMALL CLAIMS DIVISIONLF NOLL, INC705 DOUGLAS ST, STE 344SIOUX CITY IA 51101

Case: 02811 SCSC015368

vs.

JUDGMENT ENTRYDefendant(s),

KELSEY KAY BLEVINS351 S STATE RD-NVA-LAKE VIEW IA 51450

LARRY GENE BLEVINSPO BOX 284LAKE 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(s)Larry Blevins, in the amount of $1065.16 with interest at the rate of 2.12% from the 13th day ofNovember ,2013 and court costs.The Court further enters judgment for prejudgment interest in the amount of $0.92.

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. Fee:$185.00

1 of 2

E-FILED 2013 DEC 30 9:46 AM SAC - CLERK OF DISTRICT COURT


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State of Iowa Courts

Case Number Case TitleSCSC015368 L.F. NOLL, INC. VS BLEVINS, LARRY AND KELSEYType: ORDER FOR JUDGMENT

So Ordered

Electronically signed on 2013-12-30 09:46:51

2 of 2

E-FILED 2013 DEC 30 9:46 AM SAC - CLERK OF DISTRICT COURT

judgment against lake view couple in the amount $1,065.16

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