Judgment Against Sac City Woman in the Amount $1,125.23

8/12/2019 Judgment Against Sac City Woman in the Amount $1,125.23

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IN THE IOWAD ISTRICTCOURTF O R SA C CO U N T YS M ALL CLAIMS D I V I S I O N

L. F. N O L L ,INC.705DOUGLAS S T R E E T ,SUITE34 4S I O U X C ITY IA 51101PLAINTIFFVS

C A R R I E HICKSFKA CARRIE AMUNRUD612 N 5 STSA C ITY A50583 1306DEFENDANT(S)

O RIG IN A L N O T ICE A N DPETITIONFOR A MONEY JUDGMENTN O.

ToDefendant(s):1. You arenotifiedthat theabove-named Plaintiff demandsof you theamountof 1143.98. Thisclaim isbased on thevalue ofgoods and/or services suppliedby thefollowing persons orbusinessesin theamountsindicated below. Said claimsa reassignedtoPlaintiff.

CREDITORLORING HOSPITAL PRINCIPAL 1125.23 PRE-FILING INTEREST 18.752. Judgmentmay beentered againsty ou unlessyo ufile anAppearanceandAnswer with in 20 dayso f theserviceof the Original Notice upon you. Judgmentmayincludethe amount requestedplus interestandcourtcosts3. Youmust electronically filetheAppearanceandAnswer usingthe Iowa Judicial Branch ElectronicDocument Management System (EDMS) athttps://www.iowacourts.state.ia.us/EFile.unless youobtain fromthecourt anexemption from electronicfiling requirements.4. Ifyour AppearanceandAnswer isfiled within20daysand youdenytheclaim,yo uelectronicnotification through EDMSof the place andtimeof thehearingonthis matter. r iv

5. If you electronically file,EDMS will serve acopyof theAppearancea ndAnswer onPlaintiff s)or on theattorney(s)forPlaintiffs). The Notice ofElectronicFilingwillindicateifPlaintiff(s) is(are) exempt fromelectronicfiling, and if youmust mailacopyofyour AppearanceandAnswertoPlaintiff s).6. Youmust alsonotifytheclerk's officeof anyaddress change.

E-FILED 2014 JAN 20 2:45 PM SAC - CLERK OF DISTRICT COURT


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/kSSICAR.NO LLAT000887370 5 Doug las St.,S te 502Sioux City IA51101Phone 712) 224-2675Fax 712) 252-4497jrn 5)decklaw.netATTORNEY FOR PLAINTIFF0002945621JANUARY 11,2014



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IN THE IOWA DISTRICT COURTFOR SACCOUNTYSMALL CLAIMS DIVISION

F.NOLL INC.PLAINTIFFVS

CARRIE HICKSFKACARRIEAMUNRUDDEFENDANT(S)

VERIFICATION OFACCOUNTIDENTIFICATION O FJUDGMENTDEBTORA NDCERTIFICATERE

MILITARYSERVICENO

For Defendant: CARRIEHICKSFKA CARRIEAMUNRUD

1. I T. L. Noil VicePresidentof L. F. Noll Inc.,am apartyor employeeo fPlaintiff whose claim(s) is(are)shownin the attached statement(s). I have personal knowledge that the attached statement(s) is (are) a truecopyof theoriginalcreditor's records showing thebalancedue istrue an dcorrect. Ifurther statethat the sumof$1143.98 is the balancedue and owing as of JANUARY11, 2014 from Defendant(s) to Piaintiff(s) and anyinterest amount owing is accurately stated in the Petition and Original Notice.2. i further state that Defendant, CARRIE HICKS FKA CARRIE AMUNRUD. resides at 612 N 5 ST SAC CITYIA50583-1306. is employed at CASEYS GENERAL STORE 1304 W MAIN ST SAC CITY IA 50583. andDefendant's occupation is __ .3. CheckA, B or C for Defendant:A. X Defendant is not in the military service of the United States government, haveverifiedthis factby(check one):X Checking the Defense Manpower Data Center (DMDC) (requires name and SSN or name

and date of birth) https://www.dmdc.osd.mil/appi/scra/scraHome.do.a Contacting Defendant who informed me, orn Regularly seeing Defendantandbelieving Defendantis notactivein theU.S. military.OR B. O Ihave investigated,and Iam unabletodetermine whether or notDefendant is in the militaryservice of the United States government.OR C. O Defendantis in themilitaryserviceof theUnited States government.

4. Ialsostate to the best of my knowledge(checkone):Defendant O is X is not underadisabilityorconfinedin anyreformatory jail,or penitentiary. certify under penalty of perjury and pursuant to the laws of the State of Iowathatthese facts aretrueandcorrect.

L.F. NOLL

flNOLL,VtdEPRESIDENT705Douglas St., Suite344SiouxCity,IA51101712-252-0583

294562



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NCS,INC DBANOLLCOLLECTION SERVICE

AProfessional Debt Collection Service Since 1965705DOUGLAS STREET, SUITE 344

SIOUX CITY,IA51101(712)252-0583

DATE: DECEMBER 11,2013LORING HOSPITALATTNJAN WISEMAN211HIGHLANDAVESACCITY IA 50583

014345

ATTENTION:RE:CARRIEHICKS

557100 $1125.23 10/08/13Theabove debtor refuses to cooperate. We recommend further action, in

order to enforce collection. Before our attorney can proceed, we will require*Completionof theassignmentat the bottom ofthispage.* Copy of the itemized statement showing balance due {ifnotpreviouslyprovided)

* If theoriginal accountis acontractornote,wemust havetheoriginal.Pleasereturnpromptly. Court costs will be advanced on yourbehalf.

Donot accept payments or makearrangements,without calling us first.THANK YOU FOR YOUR COOPERATION

ASSIGNMENT FOR PURPOSES OF SUITForvaluable consideration, receipt hereby acknowledged, the undersigned herebyassign, transfer, and set overuntoL F Noll, Inc. that certain claim against

CARRIE HICKSJEREMY HICKS

forgoods, wares and merchandise sold and delivered or services rendered andperformed in the principal amount of $1125.23 lawful interestthereon; and does herebyauthorizesaid assignee to do and perform all actsnecessaryforcollection; commencementofsuitin thenameof theassignee,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 oftruthin lending, and that same is free ofset-offsandother defenses.

in VDated this n day ofLORING HOSPIT L

By

j c

. _(NameandOfficial Title) 0 k

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

0002943613



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NCS, INC DBANOLL COLLECTION SERVICE

AProfessional Debt Collection Service Since1965705 DOUGLAS STREET

SUITE344SIOUXCITY IOWA 51101

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

JANUARY 24, 2013

CARRIE AMUNRUD612N5 STSAC CITY IA 505831306

CREDITOR: LISTED BELOWIFMORE THANONELORINGHOSPITALACCOUNT NO.0002925139TOTAL AMOUNT DUE: $125.24AMOUNTIN DEFAULT: $125.24

YOUARE IN DEFAULT ON THIS CREDIT TRANSACTION. YOU HAVE A RIGHT TO CORRECTTHIS DEFAULT. IF YOU DOSO,YOU MAY CONTINUE WITH THE CONTRACT AS THOUGH YOUDIDNOT DEFAULT.Y U DEFAULT CONSISTSOF:FAILURETO PAY ASAGREEDCORRECT THIS DEFAULTBY: PAYINGTHEAMOUNTINDEFAULT, $125.24TONOLLCOLLECTION SERVICE, AGENTFOR THEABOVE CREDITOR.IFYOU DO NOTCORRECT THIS DEFAULT WITHIN30DAYS,WE MAYEXERCISEOURRIGHTSAGAINSTYOUUNDERTHELAW.IFYOU 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,

UNLESS YOUDISPUTETHEVALIDITYOF THEDEBTOR ANYPORTION THEREOF, WITHIN30DAYS AFTER RECEIPTOFTHIS NOTICE,WESHALL ASSUMETHEDEBTTO BEVALID. IFYOUNOTIFYUS INWRITINGOFYOUR DISPUTE WITHIN THIS30 DAYPERIOD,WEWILLOBTAIN VERIFICATION OF THEDEBTANDWILL MAILYOU ACOPY. UPON YOUR WRITTENREQUESTWITHIN A THIRTY DAY PERIOD WE WILL PROVIDE YOU WITH THE NAME AND ANADDRESSOF THEORIGINAL CREDITORIFDIFFERENT FROMTHECURRENT CREDITOR.

THIS IS ANATTEMPTTOCOLLECTADEBTANYINFORMATION OBTAINED WILLBEUSEDFORTHAT PURPOSE

CLIENT PRINCIPAL INTEREST OTHER TOTALLORING HOSPITAL $123.15 $2.09 $0.00 $125.24



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D O C T O R Lor ing-HospitalGYANO B . K. S~^

j B I L L I N G .DATE. . /\\2 P A G E 1 J 211H ighlandAve?brSac City IA50583

T E L E P H O N E N O . E X T E N S I O N712-563-6042M E D . REC. N O . / A D M I S S I O N N O .33593 / 544843

N .O . I N S U R A N C E - C O M P A N Y P O L IC Y N U M B E R P O L IC Y H O L D E R P L AN07 BLUE CROSS 140 DXM283AD9622 * PROCTOR, MICHAE05 SELF-PAY 479769038 AMUNRUD, CARRIE

G U A R A N T O R P A TI EN T N A M E M E D . R E C . N O . / A D M I S S I O N N O .CARRIE AMUNRUD CARRIE AMUNRUD 33593 / 5448436 1 2 N 5 T H S T T Y P E A D M I S S I O N DATE D I S C H A R G E D A T E B I R T H D A T E S E X A G ESAC CITY IA 50583 11 08/22/12 08/22/12 //89F 23

G U A R A N T O RIS 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 AFTER -THE I 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 ^B$V&t^HD A T E

08-2208-22

08-22

c \ r i

C H A R G EC O D EM AA A^^^^^^^^^^^^^

~^^^^^^UHf^

1 1M^ ^^ B^ J L LIIJ

la)CPa^

D E S C R I P T I O N .LEVL ~EMERGENCY R O O M

RADIOLOGY, PROFESS

RADIOLOGY, TECH

S U M M A R Y OF CHARGESEMERGENCY R O O MRADIOLOGY, PROFESSIONALRADIOLOGY, TECH

TOTAL CHARGES

BALANCE* ***7 * JJSv^-^S-^'i-^~\ 7 C ~ ~feF1^^3^~1a

Q U A N T I T Y1111

C H A R G E405.000154.300

38.670

135.000

559.3038.67

135.00

732.97

PJ-_-- -

C PT

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

9 a o l / >- N -or 1

f _

-"/5

A M O U N T405.00154.30559.30

38.6738 .67135.00135.00

732.97

S .b?la .lfc

, 9 A ^ ~ 7 l^ ' z L i _ L ^ Li~}t> ciO



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NCS, INC DBANOLL COLLECTION SERVICE

AProfessional DebtCollection Service Since 1965705 DOUGLAS STREET

SUITE344SIOUXCITY IOWA 51101

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

JUNE14,2013

JEREMY W HICKS CARRIE HICKS612N 5STSAC CITY IA 50583

CREDITOR:LISTED BELOW IF MORE THAN ONELORING HOSPITALACCOUNTNO. 0002935004TOTAL AMOUNT DUE: $385.02AMOUNT IN DEFAULT: $385.02

YOUARE IN DEFAULT ON THIS CREDIT TRANSACTION. YOU HAVE A RIGHT TO CORRECTTHIS DEFAULT. IF YOU DO SO, YOU MAYCONTINUE WITHTHECONTRACTASTHOUGHYOUDIDNOTDEFAULT.YOURDEFAULT CONSISTS OF: FAILURE TO PAY AS AGREEDCORRECTTHIS DEFAULTBY: PAYINGTHEAMOUNTINDEFAULT,$385.02TONOLL COLLECTION SERVICE, AGENT FOR THE ABOVE CREDITOR.IFYOU DO NOTCORRECT THIS DEFAULT WITHIN30DAYS,WE MAYEXERCISEOURRIGHTSAGAINSTYOUUNDERTHELAW.IFYOUDEFAULT AGAIN WITHINTHENEXT YEAR,WE MAYEXERCISEOURRIGHTS WITHOUTSENDING YOU ANOTHER NOTICE LIKE THISONE. IF YOU HAVE ANY QUESTIONS, WRITE ORTELEPHONE PROMPTLY.

SINCERELY,

UNLESSYOUDISPUTETHEVALIDITYOF THEDEBTOR ANYPORTION THEREOF, WITHIN30DAYS AFTERRECEIPTOFTHIS NOTICE,WESHALL ASSUMETHEDEBTTO BEVALID. IFYOUNOTIFY US IN WRITING OF YOUR DISPUTE WITHIN THIS 30 DAY PERIOD, WE WILLOBTAIN VERIFICATION OF THEDEBTANDWILL MAILYOU ACOPY. UPON YOUR WRITTENREQUESTWITHIN A THIRTY DAY PERIOD WEWILLPROVIDE YOU WITH THE NAME AND ANADDRESSOF THEORIGINAL CREDITORIFDIFFERENT FROMTHECURRENT CREDITOR.

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

CLIENT PRINCIPAL INTEREST OTHER TOTALLORING HOSPITAL $378.44 $6.58 $0.00 $385.02



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DOCT O R M A R C Z E W S K I , L. JI L L I N DATE01/18/13 PAGE

Lo r i n g Hosp i t a l

211 HighlandAve SacCity, A 50583

TELEPHONE NO712 730 0850

EXTENSION

MED REC NO /ADMISSION NO33836 / 551214

N O . INSURANCE COMPANY POLICY NUMBER P OL I CYHOLDER PLAN0705

BLUE CROSS140SELF-PAY

XQH316AD1263443829210

HICKS JEREMYHICKS LOGAN

GUARANTOR PATIENT NAME MED REC NO /ADMISSIONNOJEREMY HICKS

612 N 5TH STSAC CITY IA 50583

L4M HICKS 33836 / 551214P TI NTTYPE13

D MIS S ION D T E01/11/13

D I S C H R G E D T E01/12/13

B I R T H D T E. J,LJ/08

SEX

MAGE

G U R N T OR I S RE S P ON S IB L E FOR N Y M O U N T S D U E FT E R T HE IN S U R N C E C OMP N I E S M K E T HE IR P Y ME N T SD T E C H R G ECODE DESCRIPTION Q U N T I T Y C H RG E CPT M O U N T01-11

01-11

01-1101-1101-1101-11

01-1101-1201-1201-12

01-1101-12

01-1101 12

01-1101-1201-1101-12

OBSERVATION R OOM

EMERGENCY ROOM

LABORATORY

PHARMACY

nn13RADIOLOGY PROFESS

RADIOLOGY TECH

RESPIRATORY THERAP

396.00

711.000

18 . 00044 . 0004750039.500

1000010 . 0010 00010 . 00

47. G3047.630

135.000135.000

125 . 00125 00097. 0097000

DEPT TOTAL

DEPTTOTAL

DEPT TOTAL

DEPTTOTAL

DEPTTOTAL

DEPT TOTAL

DEPT TOTAL

396.00396.00

711.0711.0

18 .0044 . 0047.5079. 0188 .50

10. 010 . 0010 . 0010.0040.00

47 .6347 . 6395.26

135 . 00135. 0270 . 00

125.0125. 0194.00291.0735.00



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''

D O T O R LoringHospitalvMARCZEWSKI, L. J. O- o

B I L L I N G D A T E ]\\01/18/13 PAGE 2 J 211HighlandAve

N O .

0705

Sac City, IA 50583I 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

BLUE CROSS 140 XQH316AD1263SELF-PAY 443829210

TELEPHONE NO EXTENSION712-730-Q8SO ....M E D . REC. N O . / A D M I S S I O N N O .33836

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

HICKS,HICKS,

G U A R A N T O R P A T I E N T N A M EJEREMY HICKS L4ta

JEREMYLOGAN

/ 551214

M E D . REC. N O ./ A D M I S S I O N N O .ft HICKS 33836 / 551214

612 N 5TH ST PT Y P E NT A D M I S S I O N D A T ESAC CITY IA 50583 13 01 11 13

D I S C H A R G E D A T E B I R T H D A T E S E X A G E01/12/13 flT/1m/os M 4 '

G U A R A N T O H I SR E S P O N S I B L EF O R A N YA M O U N T S D U EA 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 T H E I R P A Y M E N T S ^Ktrft ^lD A T E

C H A R G EC O D E

C

D E S C R I P T I O NS U M M A R Y OF CHARGES

OBSERVATION R O O MEMERGENCY R O O MLABORATORYPHARMACYRADIOLOGY, PROFESSIONALRADIOLOGY, TECHRESPIRATORY THERAPY

TOTAL CHARGES

BALANCE

\Y^

C H A R G E

396.00711.00188.50

40. 0095.26

27 0. 00735 .00

2435 .76

~ ? 7

C PT

A M O U N T

2435.76

s^-\ rfi 9

~ *i f ^ f \

3-73 - - f/ >



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NCS,INC DBANOLL COLLECTION SERVICE

AProfessionalDebt Collection Service Since 1965705 DOUGLAS STREET

SUITE344SIOUX CITY IOWA 51101

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

OCTOBER 10, 2013

CARRIE HICKS JEREMY HICKS612N 5STSAC CITYIA50583-1306

CREDITOR:LISTEDBELOWIFMORE THANONELORING HOSPITALACCOUNT NO. 0002943613TOTAL AMOUNT DUE: $633.72AMOUNTINDEFAULT: $633.72

YOU ARE IN DEFAULT ON THIS CREDIT TRANSACTION. YOU HAVE A RIGHT TO CORRECTTHISDEFAULT. IF YOU DO SO, YOU MAYCONTINUE WITHTHECONTRACTASTHOUGHYOUDID NOTDEFAULT.YOURDEFAULTCONSISTSOF:FAILURETO PAY ASAGREEDCORRECT THIS DEFAULTBY: PAYINGTHEAMOUNTINDEFAULT, $633.72TONOLLCOLLECTIONSERVICE, AGENTFOR THEABOVECREDITOR.IFYOU DO NOTCORRECT THIS DEFAULT WITHIN30DAYS,WE MAYEXERCISEOURRIGHTSAGAINSTYOUUNDERTHELAW.IFYOUDEFAULT AGAIN WITHINTHENEXTYEAR, WE MAYEXERCISEOURRIGHTS WITHOUTSENDING YOUANOTHER NOTICE LIKE THIS ONE. IF YOUHAVEANYQUESTIONS, WRITEORTELEPHONE PROMPTLY.

SINCE

NOLLCOLLECTION SERVICEUNLESS YOUDISPUTETHEVALIDITYOF THEDEBTOR ANYPORTION THEREOF, WITHIN30DAYS 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 ACOPY. UPON YOUR WRITTENREQUEST WITHIN A THIRTY DAY PERIOD WE WILL PROVIDEYOU WITH THE NAME AND ANADDRESSOF THEORIGINAL CREDITORIFDIFFERENT FROMTHECURRENT CREDITOR.

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

CLIENT PRINCIPAL INTEREST OTHER TOTALLORINGHOSPITAL $623.64 $10.08 $0.00 $633.72



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O T O R - LoringHospitalROH, SIMON S~v

B I L L I N G D A TE J\ >r06/07/13 PAGE 1 J 211HighlandAve Sac City IA5 583

T E L E P H O N E N O . E X T E N S I O N712 563 6042M E D . REC. N O . / A D M I S S I O N M O .33593 / 557100

N O . I N S U R A N C E C O M P A N Y P O L IC Y N U M B E R P O L IC Y H O L D E R P L AN07 BLUE CROSS 140 DXM283AD9622 PROCTOR , MICHAE05 SELF-PAY 479769038 HIC KS, CARRIE

G U A R A N T O R P A T IE N T N A M E . MED. REC. N O . / A D M I S S I O N N O .CARRIE HICKS CARRIE HICKS 33593 / 557100

612 N 5THSAC CITY

PATIENT 'STREET TY PE 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 I R T H D A T E S E X A G EIA 50583 11 06/01/13 06/01/13 3039F 24

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 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 SD A T E

06-01

06-01

06-01

06-01

06-0106 01

C H A R G EC O D EgMHMBV

^ Û}

M ^ u u a rD E S C R I P T I O N

îl.^J ÊMERGENCY RM PROFE

JLjEMERGENCY R O O MÎliUUlfTffiELABORATORY

REFERRAL LABORATOR

PHARMACY

S U M M A R Y OF CHARGESEMERGENCY RM PROFESSIONALEMERGENCY R O O MLABORATORYREFERRAL LABORATORYPHARMACY

TOTAL CHARGES

BALANCE

^

U A N T I T Y

11

22

u -

^

C H A R G E145.000

405.000

18.000

45.400

2 .5602 .560

145.00405.0018.0045.4010.24

623 . 64

r_ 1TVDEPT TOTAL

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

DEPT TOTAL

X

PAY LAST BA L A NCE Mi lA M O U N T

145 .00145.00

405. 004 0 5 . 0 0

18.0018.00

45 .4045.40

5.125.12

10.24

623.64



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E-FILED 2014 FEB 26 1:12 PM SAC - CLERK OF DISTRICT COURT


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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 SCSC015401

vs.

JUDGMENT ENTRYDefendant(s),

CARRIE HICKS612 N 5 STSAC CITY IA

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 $ 1,125.23 with interest at the rate of 2.12 % from the 20th day of January, 2014 andcourt costs.The Court further enters judgment for prejudgment interest in the amount of $18.75.

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: $

1 of 2



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State of Iowa Courts

Case Number Case TitleSCSC015401 L.F. NOLL, INC. VS HICKS, CARRIE FKA AMUNRUDType: ORDER FOR JUDGMENT

So Ordered

Electronically signed on 2014-02-27 21:29:59

2 of 2


Documents

Judgment Against Sac City Woman in the Amount $1,125.23