small claims case against sac city man dismissed

IN THE IOWA DISTRICT COURT FOR SAC COUNTYSMALL CLAIMS DIVISION

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

PLAINTIFF

VS

DYLAN J. BRUNS1421 HOBBSSTSAC CITY IA 50583

DEFENDANT(S)

ORIGINAL NOTICE AND PETITIONFOR A MONEY JUDGMENT

NO.

To Defendant(s):1. You are notified that the above-named Plaintiff demands of you the amount of $464.38. 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.

CREDITORLORING HOSPITAL

PRINCIPAL$454.14

PRE-FiLiNG INTEREST$10.24

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 https://www.iowacourts.state.ia.us/EFile. unless you obtain fromthe court an exemption from electronic filing requirements.

4. [f your Appearance and Answer is filed within 20 days and you deny the claim, you 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 and 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 JUN 03 10:42 AM SAC - CLERK OF DISTRICT COURT

SSICA R. NOLL ATG008873.705 Douglas St., Ste. 5.02 "}Sioux City !A 51101Phone (712) 224-2675Fax (71-2y 252-4497jrn (ajdecklaw.netATTORNEY FOR PLAINTIFF

0002950005MAY 27, 2014 .


IN THE IOWA DISTRICT COURT FOR SAC COUNTYSMALL CLAIMS DIVISION

L. F, NOLL, INC.PLAINTIFF

VS

DYLAN J. BRUNSDEFENDANT(S)

VERIFICATION OF ACCOUNTIDENTIFICATION OF JUDGMENTDEBTOR AND CERTIFICATE RE

MILITARY SERVICE

NO.

For Defendant: DYLAN J. BRUNS

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 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 $464.38 is the balance due and owing as of MAY 27, 2014 from Defendant(s) to Plaintiff(s) and any interestamount owing is accurately stated in the Petition and Original Notice.

2. ! further state that Defendant, DYLAN J. BRUNS. resides at 1421 HOBBS ST SAC CITY IA 50583. isemployed at EAST SAC HIGH SCHOOL 801 JACKSON ST LAKE VIEW IA 51450. and Defendant'soccupation 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 factby (check one):

X Checking the Defense Manpower Data Center (DMDC) (requires name and SSN or nameand date of birth) httos://www.dmdc.osd.mil/appi/scra/scral-lome.do.n Contacting Defendant who informed me, orD Regularly 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 militaryservice of the United States government.

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.

LF. NOLL, INC.

T. L NOLL, VfCE PRESIDENT705 Douglas St., Suite 344Sioux City, IA51101712-252-0583

0002950005


NCS, INC DBANOLL COLLECTION SERVICE

"A Professional Debt Collection Service Since 1965"705 DOUGLAS STREET

SUITE 344SIOUX CITY IOWA 51101

(712) 252-0583FAX (712) 233-3404

AUGUST 13, 2013

DYLAN J BRUNS1421 HOBBS STSAC CITY IA 50583

CREDITOR: LISTED BELOW IF MORE THAN ONELORING HOSPITALACCOUNT NO. 0002939607TOTAL AMOUNT DOE: $407.03AMOUNT IN DEFAULT: $407.03

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 YOUDID NOT DEFAULT.

YOUR DEFAULT CONSISTS OF: FAILURE TO PAY AS AGREED

CORRECT THIS DEFAULT BY: PAYING THE AMOUNT IN DEFAULT, $407.03 TONOLL COLLECTION SERVICE, AGENT FOR THE ABOVE CREDITOR.

IF YOU DO NOT CORRECT THIS DEFAULT WITHIN 30 DAYS, WE MAY EXERCISE OUR RIGHTSAGAINST YOU UNDER THE LAW.

IE" YOU DEFAULT AGAIN WITHIN THE NEXT YEAR, WE MAY EXERCISE OUR RIGHTS WITHOUTSENDING YOU ANOTHER NOTICE LIKE THIS ONE. IF YOU HAVE ANY QUESTIONS, WRITE ORTELEPHONE PROMPTLY.

SINCERELY,

NOLL CO

UNLESS YOU DISPUTE THE VALIDITY OF THE DEBT OR ANY PORTION THEREOF, WITHIN 30DAYS AFTER RECEIPT OF THIS NOTICE, WE SHALL ASSUME THE DEBT TO BE VALID. IFYOU NOTIFY US IN WRITING OF YOUR DISPUTE WITHIN THIS 30 DAY PERIOD, WE WILLOBTAIN VERIFICATION OF THE DEBT AND WILL MAIL YOU A COPY. UPON YOUR WRITTENREQUEST WITHIN 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 TO COLLECT A DEBTANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE

CLIENT PRINCIPAL INTEREST OTHER TOTALLORING HOSPITAL $398.46 $8.57 $0.00 $407.03


NCS, Inc.dbaNoll Collection Service"A Professional Debt Collection Service Since 1965"

LORING HOSPITAL

0002947S4S

S103.20

Si 03.20

December 20, 2013

( THIS ACCOUNT HAS BEEN LISTED WITH OUR AGENCY FOR ^1 COLLECTION. jV__ I ' ' .MM', ".:,— ! X

DEAR-DYLAN J BRUNS,

YOU ARE IN DEFAULT ON THIS CREDIT TRANSACTION. YOU HAVE A RIGHT TO CORRECT THISDEFAULT. IF YOU DO SO, YOU MAY CONTINUE WITH THE CONTRACT AS THOUGH YOU DIDNOT DEFAULT.

YOUR DEFAULT CONSISTS OF: FAILURE TO PAY AS AGREED

CORRECT THIS DEFAULT BY: PAYING THE AMOUNT IN DEFAULT, $103.20 TO NOLLCOLLECTION SERVICE, AGENT FOR THE ABOVE CREDITOR.

IF YOU DO NOT CORRECT THIS DEFAULT WITHIN 30 DAYS, WE MAY EXERCISE OUR RIGHTSAGAINST YOU UNDER THE LAW.

IF YOU DEFAULT AGAIN WITHIN THE NEXT YEAR, WE MAY EXERCISE OUR RIGHTS WITHOUTSENDING YOU ANOTHER NOTICE LIKE THIS ONE. IF YOU HAVE ANY QUESTIONS, WRITE ORTELEPHONE PROMPTLY.

UNLESS YOU DISPUTE THE VALIDITY OF THE DEBT OR ANY PORTION THEREOF, WITHIN 30DAYS AFTER RECEIPT OF THIS NOTICE, WE SHALL ASSUME THE DEBT TO BE VALID. IF YOUNOTIFY US IN WRITING OF YOUR DISPUTE WITHIN THIS 30 DAY PERIOD, WE WILL OBTAINVERIFICATION OF THE DEBT AND WILL MAIL YOU A COPY. UPON YOUR WRITTEN REQUESTWITHIN A THIRTY DAY PERIOD WE WILL PROVIDE YOU WITH THE NAME AND AN ADDRESSOF THE ORIGINAL CREDITOR IF DIFFERENT FROM THE CURRENT CREDITOR.

SINCERELY,

NOLL COLLECTION SERVICE

\Ve offer convenient Payment Options

Mail payment inenclosed envelope

Pay online:www.ncscollects.com

Call us:(712) 252-0583

THIS IS AN ATTEMPT TO COLLECT A DEBT,ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.

^In^JOMSpUGl. AS STREET, SUITE 344, Sjp_UX_CITY_IA 51_1 01, PH:_(7_12) 252-058^ FAX: (712)-233-3404, Email: [email protected]"_ _ _ _ _ _Please Detach And"Retlini in The Enclosed .Envelope With YourPayrrienl"

/at; raiM^iycjimeREO HJGARDJER nEASECFicao in? BE J

PO BOX 593SIOUX CITY IA 51102-0593

Personal & Confidential

DYLAN J BRUNS1421HOBBSSTSAC CITY, IA 505S3-1535

VISA

CARD NUMBER

ACCOUM *

V OOD2947S48AMOUNT DUE

SI 03.20

NCS INCPO BOX 593SIOUX CITY IA 51102-0593

304Noll Collection.*Id

~ 00000050


NCS, INC DBANOLL COLLECTION SERVICE

"A Professional Debt Collection Service Since 1965"705 DOUGLAS STREET, SUITE 344

SIOUX CITY, IA 51101(712) 252-0583

DATE: APRIL 21, 2014

LOR1NG HOSPITAL 014345ATTN JAN WISEMAN211 HIGHLAND AVESAC CITY IA 50583

ATTENTION:

RE: DYLAN J BRUNS

549854 $454.14 08/09/13The above debtor refuses to cooperate. We recommend further action, in

order 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 notpreviously provided)

* If the original account is a contract or note, we must have theoriginal.

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

DYLAN J BRUNS

for goods, wares and merchandise sold and delivered or services rendered andperformed in the principal amount of $454.14 lawful interestthereon; and does hereby authorize said assignee to do and perform all actsnecessary for collection; comraencement 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 this A*r day of

;Name and Official Title)

THIS IS AN ATTEMPT TO COLLECT A DEBT,ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE

0002939607


- , ." DOCTOR

PEK, Z. L.

BILLING DATE

-orintf

o °rft A

Hospiral TELEPHONE wo. EXTENSION-v^P 712-210-6393

sX\/\. REC. NO. /ADMISSION NO.

02/13/13 PAGE 1 j 211 Highland Ave- Sac City, !A 50583 16586 / 549854

NO. INSURANCE COMPANY POLICY NUMBER POLICY HOLDER PLAN

07 BLUE CROSS 140 XQH392AD630405 SELF-PAY 482197552

GUARANTOR

DYLAN J BRUNS

1421 HOBBS ST

SAC CITY IA 50583

BRUNS, DYLAN JBRUNS, DYLAN J

PATIENT NAME MED. REC. NO. / ADMISSION NO.

PATIENTTYPE

11

DYLAN J BRUNS ' 16586 / 549854

ADMISSION DATE DISCHARGE DATE BIRTHDATE SEX AGE

12/12/12 12/12/12 »/»/91 M 21

GUARANTOR IS RESPONSIBLE FOR ANY AMOUNTS DUE AFTER THE INSURANCE COMPANIES MAKE THEIR PAYMENTS ^^HlfTFTTO^^^I

DATE

12-12

12-1212-1212-1212-12

12-12

12-12

12-12

12-12

12-12

12-12

CHARGECODE

^^~WMM*»

^*mr4BMBK3HHJHV^^^^MVA^W^^^^n^^^w

•̂•••V«•••••»

— ~

77f~J~

»—

DESCRIPTION

EMERGENCY ROOM

INFUSION/CHEMO THE

^MMBmJMN^WHMHBBSSSBBMl^^^WI^H^NBHi^^^^^^S^^^^^^B^^^I^Hi£89HC3BM»JM^H^HIi^HBIBH^HMHBiHBftiinl^P

^•aofeVBMBHMVMMtLABORATORY

•PHARMACY

«M^MttRADIOLOGY , PROFESS

.RADIOLOGY, TECH

»

QUANTITY

1

1

1

1

1

1

1

2

1

1

1

CHARGE

102 . 0 0 0

18 .000

3 6 . 2 4 0

45.680

12 . 56044 .000

47 .500

38 .480

39 .500

115.000

4 7 . 6 3 0

135 .000

CPT

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

AMOUNT

4 0 5 . 0 0

405.00

102 . 00

102. 00

18 . 00

36 .24

45 .6812 . 56

44 .0047 .50

38 .4879. 00

321.45

115.00

131. 00

60 . 12

4 7 . 6 3

107.75

135.00135.00

270.00


DOCTOR

PEK, Z. L.

BILLING DATE

02/13/13 PAGE 2

NO. INSURANCE COMPANY

07 BLUE CROSS 14005 SELF -PAY

GUARANTOR

DYLAN J BRUNS

1421 HOBBS STSAC CITY IA 50583

Loring" Hospital°/~v~\o /( IV o'KXATr

211 Highland Ave -Sac City, !A 50583

TELEPHONE WO. , EXTENSION

712-210-6393

MED. REC. NO. / ADMISSION NO.

16586 / 549854

POLICY NUMBER POLICY HOLDER PLAN

XQH392AD6304 BRUNS, DYLAN J

482197552 BRUNS, DYLAN J

PATIENT NAME MED. REC. NO. / ADMISSION NO.

DYLAN J BRUNS 16586 / 549854

PATIENTTYPE ADMISSION DATE DISCHARGE DATE BIRTHDATE SEX AGE

11 12/12/12 12/12/12 •/•/SI M 21

GUARANTOR IS RESPONSIBLE FOR ANY AMOUNTS DUE AFTER THE INSURANCE COMPANIES MAKE THEIR PAYMENTS ^^•^TTTf^^^H

DATE CHARGECODE

3%

DESCRIPTION

SUMMARY

EMERGENCYOF CHARGES

ROOMINFUSION/CHEMO THERAPY

LABORATORY

PHARMACY

RADIOLOGY, PROFESSIONAL

RADIOLOGY, TECH

TOTAL CHARGES

BALANCE

J 37-"^

Lj^L—A/ /y

\T PAYMENT MADE 2/4

TOTAL DUE:

QUANTITY

/14:

CHARGE

405. 00

102.00

321.46

131.00

107.75

2 7 0 . 0 0

1337.21

s

' •-/'

CPT

3/6-- /'3p/T^

f>A— ' """

y

f

AMOUNT

1337 .21

jCj "̂ q_$-i '

1^2^ i

^fe^s^l^1

-$ ""45^5$3sa-fei


DOCTOR ] Loiing HospitalLANKFORD, TONYA Q °/~V

BILLING DATE J\ >*07/11/13 PAGE 1 J 211 Highland Ave • Sac City, IA 50583

TELEPHONE NO. EXTENSION

712-210-6393


16586 / 558447

NO, INSURANCE COMPANY • POLICY N U M B E R POLICY HOLDER PLAN

07 BLUE CROSS 140 XQH392AD6304 BRUNS, DYLAN J

05 SELF-PAY 482197552 BRUNS, DYLAN J

GUARANTOR PATIENT NAME MED. REC. NO. / ADMISSION NO.

DYLAN J BRUNS DYLAN J BRUNS 16586 / 558447

1421 HOBBS ST TYPE ADMISSION DATE DISCHARGE DATE BIRTHDATE SEX AGE

SAC CITY IA 50583 36 07/02/13 07/02/13 «•/**/ 91 M 22

GUARANTOR IS RESPONSIBLE FOR ANY AMOUNTS DUE AFTER THE INSURANCE COMPANIES MAKE THEIR PAYMENTS

DATE

07-02

07-02

07-02

07-02

07-02

07-02

07-02

07-02

CHARGECODE

«MOTH»aMMftMMMMft

VHMb

^MOl

•^MBft

VMBM.4BBMB

^

DESCRIPTION

WMHMHHB*Mi<flVV^MHBPECSSB^VLABORATORY

OrEKG

JMMH0RADIOLOGY, TECH

•̂•••••M*MI^BHMHM^HPB^

RESPIRATORY THERAP

SUMMARY OF CHARGES-

LABORATORY

EKGRADIOLOGY, TECH

RESPIRATORY THERAPY

TOTAL CHARGES

BALANCE

mo

Mo^

QUANTITY

1

1

1

1

1

1

1

1

4

CHARGE

18.000

93 . 880

44 . 000

91.000

169.000

148.500

84. 000

284. 000

2 4 6 . 8 8

169.00

148.50

368 . 00

932.38

' // O <

CPT

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

^^•>

PAY LAST 1BALANCE 1

AMOUNT

18.00

9 3 . 8 8

44 . 00

91.002 4 6 . 88

169. 00

169.00

. 148.50

148 . 50

84 .00

284 . 00

3 6 8 . 0 0

932.38

*7(^C^ O^~^

I I S . 0^

^— ̂


DOCTOR Lorintr HospitalLEIGH, HUGH 4j^ Q °S~^

BILLING DATE /\ ?br05/24/13 PAGE 1 J 211 Highland Ave -Sac City, IA 50583

TELEPHONE NO. EXTENSION

712-210-6393


16586 / 556581

NO. INSURANCE COMPANY POLICY N U M B E R . POLICY HOLDER PLAN

07 BLUE CROSS 140 XQH392AD6304 BRUNS, DYLAN J

05 SELF-PAY 482197552 BRUNS, DYLAN J

GUARANTOR PATIENT NAME MED. REC. NO. / ADMISSION NO.

DYLAN J BRUNS DYLAN J BRUNS 16586 / 556581

1421 HOBBS ST TYPE ADMISSION DATE DISCHARGE DATE EIRTHDATE SEX AGE

SAC CITY IA 50583 11 05/18/13 05/18/13 M/Vf 51 M 22

GUARANTOR IS RESPONSIBLE FOR ANY AMOUNTS DUE AFTER THE INSURANCE COMPANIES MAKE THEIR PAYMENTS

DATE

05-18

05-18

05-18

05-18

05-1805-18

05-18

CHARGECODE

MMMt

\N

EMERGENCY RM PROFE

EMERGENCY ROOM

INFUSION/CHEMO THE

LABORATORY

IV SOLUTIONS

SUMMARY OF CHARGES

EMERGENCY RM PROFESSIONAL

EMERGENCY ROOM

INFUSION/CHEMO THERAPY

LABORATORY

IV SOLUTIONS

TOTAL CHARGES

BALANCE

2)

*? . InO *\^

a*.

QUANTITY

1

1

1

1

1

1

1

ot_

CHARGE •

145.000

4 0 5 . 0 0 0

168 . 000

18. 000

44.000

91.000

13 . 060

145.00

405 . 00

168.00

153 .00

13.06

884 .06

^•^

CPT

DEPT TOTAL

DBPT TOTAL

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

£>(LP<34 !•/! .0Lf> - 1 H - 'J3

^T'S" ^L^/

PAY LAST 1BALANCE 1

AMOUNT

145 .00

145.00

4 0 5 . 0 0

405 .00

168.00

168 . 00

18.0044.00

91. 00

153 . 00

13.06

13.06

884 .06

x^.QjVi

^fefry.


small claims case against sac city man dismissed

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