Post on 01-Jun-2018
transcript
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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IN THE IOWA DISTRICT COURT FOR SAC COUNTY
SMALL CLAIMS DIVISION
L.
F. NOLL INC
70 5 DOUGLAS STREET SUITE 34 4
SIOUX CITY
IA
51101
PLAINTIFF
VS
MICHELLE A. BIRD
50 1
S
MAIN
ST
PO BOX 407
ODEBOLT IA 51458-0407
ROBERT BIRD SR
501 S MAIN ST
PO BOX 407
ODEBOLT IA 51458-0407
DEFENDANT(S)
ORIGINAL NOTICE
AND
PETITION
FOR A MONEY JUDGMENT
NO
To Defendant(s):
1.
You are notified that the above-na me d P laintiff dem and s of you the amoun t of 846.40. This claim is
based on the value of goods an d/or services
supplied
by the following persons or businesses in the amounts
indicated below. Said claim s a re assigned to Plaintiff.
CREDITOR
PRINCIPAL
SIOUXLAND
UROLOGY
ASSOCIATES
388.80
SIOUXLAND OBSTETRICS
&
GYNECOLOGY,
PC
435.60
TOTAL
824.40
PRE-FILING
INTEREST
7.14
14 86
22.00
2
Judgm ent may be entered against you unless
you
file
an
Appearance
and
Answer within 20 days
of th
service of the Original Notice upon
you.
Judgment may include the amount requested plus interest and
cour
costs.
3.
You
must electronically file
the
Appearance
and Answer
using
the
Iowa
Judicial Branch Electronic
Document Management System (EDMS)
at
https://www.iowacourts.state-ia.us/EFile. unless
yo u
obtain from
the
court
an
exemption from electronic filing requirements.
4. If your Appearan ce and Answer is filed within 20 days and you deny the claim, you will receive
electronic notification through EDMS
of the
place
an d
time
of the
hearing
on
this m atter.
5. If you electron ically file, EDMS will serve a copy of the Appearance and Answe r on Plaintiff(s) or on the
attorney (s) for Plaintiff(s). The Notice of Electronic Filing will indicate if Plaintiff(s) is (are) exempt from
electronic filing, and if you must mail a copy of your Appearance and Answer to Plaintiff(s).
6.
You mu st also notify the
clerk's
office of any address change.
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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iSlCA
R. NOLL AT0008873
Douglas St. Ste 502
Sioux
City IA 51101
Phone 712) 224-2675
Fax 712) 252-4497
jrn@decklaw.net
ATTORNEY
FOR
PLAINTIFF
0002973482
NOVEMBER 24, 2014
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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IN THE IOW DISTRICT COURT FOR S C COUNTY
SM LL CL IMS DIVISION
L. F. NOLL INC.
PLAINTIFF
VS
NO.
MICHELLE A. BIRD
ROBERT BIRD SR.
DEFENDANT(S)
VERIFICATION OF
ACCOUNT
IDENTIFICATION O F JUDGMENT
DEBTOR AND CE RTIFICATE RE
MILITARY
SERVICE
For
Defendant: MICHELLE A. BIRD
1 . I, T. L.
Noll, Vice President
of L. F.
Noll,
Inc. am a
party
or
employee
of
Plaintif f whose claim(s)
is
(are)
shown
in the a ttached statement(s). I have personal know ledge that the attached statem ent(s) is (are) a true
copy
of the original creditor's records showing the ba lance due is true and correct. I further sta te that the sum
of 846.40 is the balance due and owing as of NOVEMBER 24, 2014 from Defendant(s) to Plaintiff(s) and an
interest amount owing
is
accu rately stated
in the
Petition
and
Original Notice.
2.
I
further state
that Defendant
MICHELLE
A.
BIRD resides
at 501 S MAIN ST PO BOX 407
ODEBOLT lA
51458-0407, is employed at SHADY OAKS CARE CENTER 1409 W MAIN ST LAKE CITY IA 51449. and
Defendant's occupation is .
3.
Check
A, B, or C for
Defendant:
A.
X Defendant is not in the m ilitary service of the United S tates governme nt, I have verified this fa
by
(check one):
X
Che cking the Defense Manpower D ata Center (DMDC) (requires name and SSN or nam e
and date of birth)
https: //www.dm dc.osd.mi l /appj/scra/scraHome-do.
Contacting Defendant
who
informed
m e, or
Regularly seeing Defendant
and
believing Defendant
is not
active
in the
U.S. mil itary.
OR B. O I
have investigated,
and I am
unable
to
determine whether
or not
Defendant
is in the
m ilitary
service
of the
United States governm ent.
OR C. O
Defendant
is in the
military service
o f the
United States government.
4. I
also state
to the
best
of my
knowledge (check one):
Defenda nt O is X is not under a disa bility or confined in any reform atory, jail, or penitentiary.
I
certify
under
penalty
of
perjury
a nd
pursuant
to the
laws
of the
State
of
Iowa that these facts
are true and
correct.
L.F. NOLL INC.
T.
L.
NOLL,
VICE
PRESENT
705 Douglas St., Suite 3 44
Sioux
City, IA 5 1 1 0 1
712-252-0583
0002973482
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
http://slidepdf.com/reader/full/scsc015550-judgment-against-odebolt-couple-in-the-amount-82400pdf 5/20
NOTICF,
OF
RIGHT
TO CURE
DEFAULT
NCS, INC DBA
NOLL
COLLECTION
SERVICE
705 DOUGLAS STREET,
S'JITE
344
PO BOX 593
SIOUX
CITY
TA
51102-0593
712)252-0583
NOVEMBER
4, 2014
MICHELLE A BIRD
ROBERT BIRD
SR
501 S MAIN ST
PO BOX 407
ODE3CLT IA 514580407
RE :
(LISTED BELOW IF MOR E THAN
ONE)
TOTAL AMOUNT
DUE:
846.40
AMOUNT
IN
DEFAULT: 846.40
You are now in default on this credit
transaction..
You have a right to
correct this default within 20 days. If you do so, you may continue wi th the
contract
as
though
you did not
default.
YOUR
DEFAULT CONSISTS OF: FAILURE TO PAY AS AGREE D
Correct t his default by: Paying the amount ir default, S846.4C to
Noll Collection Se rvice, agent for the above
creditor.
If you do not correct this defa ult within 20 days, we may exercise ou r
rights against you under the
law.
If
you de fault again in the next year, we may exercise our rights without
sending you another notice like this one. If you have any questions, write or
teIephone promptly.
THIS
IS
AN ATT EMPT
TO
COLLECT
A
DEBT,
AN Y
AND ALL
INFORMATION OBTAINED WILL
BE
USED
FOR
THAT PURPOSE.
Client Ref No
Princip al Interest
SIOUXLAND
UROLO
00423848 388.80
7.14
S10UXLAN D OBSTE 44734 435.60
14.86
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
http://slidepdf.com/reader/full/scsc015550-judgment-against-odebolt-couple-in-the-amount-82400pdf 6/20
NCS, INC DBA
NOLL COLLECTION SERVICE
A
Professional Debt Collection Service Since 1965
705 DOUGLAS STREET, SUITE
344
SIOUX CITY, IA 51101
(712) 252-0583
DATE:
OCTOBER 24,
2 14
SIOUXLAND
UROLOGY ASSOCIATES 025500
P O BOX
2020
NORTH SIOUX CITY 3D 570492020
ATTENTION:
RE: MICHELLE A BIRD
00423848 $388.80 04/18/14
The 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 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 SUIT
For valuable consideration, receipt hereby acknowledged, the undersigned hereby
assign,
transfer, and set over unto L.F. Noll, Inc. that certain claim against
MICHELLE
A
BIRD
ROBERT
BIRD
SR
for goods, wares and merchandise sold and delivered or services rendered and
performed in the principal amount of $388.80 plus lawful interest
thereon; and does hereby authorize said assignee to do and perform all acts
necessary for collection; commencement of suit in the name of the assignee,
settlement, adjustment, compromise or satisfaction of said claim. Assignor
hereby certifies that said claim is justly due and owing and warrants
compliance
with requirements
of the
Iowa Consumer Credit Code
as
well
as
disclosure and
other provisions
of
truth
in
lending,
and
that same
is free of
set-offs and other
defenses.
Dated
thia?f
day of
SIOUXLAND UROLOGY ASSOCIATE
By:
THIS IS TT
ATTEMPT
TO
COLLECT
A
DEBT,
INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE
0002960040
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
http://slidepdf.com/reader/full/scsc015550-judgment-against-odebolt-couple-in-the-amount-82400pdf 7/20
Account Ledger
Urology Associates
Box 2020
Dunes, SD 57049
(605)217-7010
Bird
1 S Main
Box 407
51458
(712) 490-684.
Ph one:
2 5 7 - 0 0 -
1 0 9 - 0 0 -
2 2 • 8 0 -
5 8 3 8
:count:
00423848
ssponsible
Party:
Self
urance 1 (HSV807621451) BCBS Iowa
Wellmark
Patient Balance
Insurance Pending
Total
S22.80
$117.00
Current
0.00
$0.00
— rrimary
Provider:
(18) And rew Bourne
Referring
P hysician: (924) Shelly E lse
Account Balance
1to3 31 to
6 0
61 to
90 91 to 120 121 to 150
0.00 0.00 0.00 0.00 22.80
$117.00 $0.00 $0.00 $0.00 $0.00
Ove
Provider
Bourne
I (18) Bourne
A (18) Bourne
A (18) Bourne
(18 ) Bourne
I
(18 ) Bourne
A (18) Bourne
A (18) Bourne
M
Memo
M Memo
Entry Da te: 10/02/2013
(16)Kassin
PA-C
I
(16)
Kassin
PA-C
A
(16) Kass in PA-C
A (16) Kassin PA-C
M Memo
M Memo
Entry Date: 12/17/2013
(18) Bourne
I (18) Bourne
A
(18)
Bourne
M Memo
M Memo
Entry Date:
05/22/2014
(18) Bourne
M Mem o
Entry Date: 10/17/201 4
ill
Status Service Date Code Description Charqe P ayment
Bill
09/26 /201309/26 /2013
$285.00
Bill 10/21/2013 10/21/2013 3 0 BCBS
Iowa
Wellmark
0034236410
Bill 10/21/2013 10/21/2013 CO 45
0
Charges exceed contracted
fee
schedule
Bil l 04/17/201 4 04/17/2014 C 0 Collection Write O ff
Bi ll 09/26/2013 09/26/201 3 $158.00
Bi ll 10/21/2013 10/21 /2013 3 0 BCBS Iowa
Wellmark
0034236410
Bid
10/21/2013 10/21/2013 CO 45 0 Charges exceed contracted fee
schedule
Bil l 04/17/20 14 04/17/2014 C 0 Collection Write O ff
10/02/2013 Ins
Code sequence
on
visit [3];
by
user:
DBertrand
1
0/21/201
3
$366.00 appl ied to deductible.
Visit Balance: $0.00 $443.00 $0.00
Bill
12/05/201312/05/2013
$117.00
Bi l l 01 /14/201401 /14/2014
3 0
BCBS Iowa Wellmark ($91.20)
0034253558
Bill 01/14/2014 01/14/2014 CO45
0
Charges exceed contracted
fee
schedule
Bil l 04/1 7/201 4 04/17/2014
C 0
Collection Write
O ff
12/17/2013 Ins Code sequence on visit [3]; by user:
DBertrand
01/14/2014 $22.80 appl ied to co-payment.
Visit Balance: 0.00 $117.00 ($91.20)
Bi ll 05/08/20140 5/08/2014 $117.00
Bill 0 6 / 16 / 2 0 14 0 6 / 16 / 2 0 14
3 0
BCBS Iowa Wellmark ($91 .20)
0034283500
Bill
06/16/2014 06/16/2014
CO45 0
Charges exceed contracted
fee
schedule
05/22/2014 Ins Code sequence on visit [3]; by user:
DBertrand
06/16/2014 $22.80 appl ied to co-payme nt.
Visit Balan ce: $22.80 117.00 ($91.20)
No
ll 10/09/2014 10/09/2014 $11 7,00
10/17/2014 Ins Code sequence on visit
[3];
by user:
DBertrand
Visit Balance: 117.00
117.00
$0.00
Ad
($
($2
(S
($1
($4
(
($
($
(
(
Bill:
22.80
No-Bill: 117.00
Total :
139.80
794.00
( 182.40)
Charge ;
I =
Insurance Payment;
P =
Private P ayment;
A = Adjustment; F =
Insurance Filing;
M = Memo
All Vis i ts
a
preliminary (open) transaction that
is
subject
to
review.
( 4
Created
by : RTorres
ID:
17 Ver
1 .15 .2 .9
Page
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
http://slidepdf.com/reader/full/scsc015550-judgment-against-odebolt-couple-in-the-amount-82400pdf 8/20
F r o m S i o u x l a n d O b g y n
7122772645
10/21/2014
09:20 #556 P.002/00
NCS, INC DBA
NOLL COLLECTION SERVICE
A
Professional
Debt Collection Service Since 1965
705 DOUGLAS STREET, SUITE 344
SIOUX CITY,
IA
51101
(712) 252-0583
DATE:
OCTOBER
24 2014
SIOUXLAND OBSTETRICS &
026122
GYNECOLOGY PC
2730 PIERCE ST SUITE 201
SIOUX CITY, IA 51104
ATTENTION:
RE: MICHELLE A 3IRD
44734
$435.60 10/17/14
The above debtor refuses to
cooperate.
We recommend
further
action, in
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.
r o z accept payments
or
make arrangements, without calling
us
first.
THANK
YOU FOR
YOUR COOPERATION
ASSIGNMENT FOR PURPOSES OF SUIT
r valuable consideration, receipt hereby acknowledged, the undersigned hereby
transfer, and set over unto L.F. Noll, Inc. that certain claim against
MICHELLE A
BIRD
ROBERT
BIRD
SR
goods, wares and merchandise sold and delivered or services rendered and
in the principal amount of $435.60 plus lawful interest
does hereby authorize said assignee to do and
perform
all acts
for collection; commencement of suit in the
name
of the
assignee,
compromise or satisfaction of said claim. Assignor
that said claim is justly due and owing and warrants
with requirements of the Iowa Consumer Credit Code as well as
and ether provisions of truth in lending, and that same is free of
other defenses.
this
OBSTETRICS &
(Name and
O f f i a l
THIS
IS AN
ATTEMPT
TO
COLLECT
A
DEBT,
AMY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
http://slidepdf.com/reader/full/scsc015550-judgment-against-odebolt-couple-in-the-amount-82400pdf 9/20
Pr in ted : 09/16/2014
12:16
P M
User: M T Y L O R
Financial
Group: 2-SIOUXLAND OBGYN PC SIOUX CITY
Guar :
44734
Guar: MICHELLE A. BIRD
FinOass: PRIVATE
P A Y
Guarantor
A d d r e s s :
t G
501 S
MAIN
ST
PO BOX 407
ODEBOLT, IA 51458
Home: (712)210-3539
Work:
Guarantor Employer: None
Bird
Sp ru i t
SIOUXLAND
OBGYN PC
ACCOUNT
DETAIL REPORT
Guar
Account Balance:
$
435 60
0
- 30 days :
0.00
31
to
60 d a y s :
0.00
61 to 90
days
:
0.00
91 to 120 days: 0.00
121 to 150 days 0.00
Over 150 days: 435.60
Last Statement Date: 04/30/2014
Patient
:
Patient:
45733
Patient Balance: 4 3 5 . 6 0 Insurance Balance: $ 0.00 Collection Balance:
MICHELLE
A. BIRD
Patient Address:
501 S
MAIN
ST
P O BOX 407
ODEBOLT,
IA
51458
Home: (712)210-3539
Work: (712) -
Patient Employer: None
Enc.
Date: 10/08/2013
E n c .
;
Blling Provider: 2-EASTMAN
MD, PAUL
J
Primary Diagnosis
for
this
Encounter:
61917 Enc. Post
Date:
02/12/2014 Loc:
Examining Provider:
2-EASTMAN
MD PAUL J Referring Provider:
BCBS
PAY MENT
BCBS ADJUSTMENT
RESPONSIBILITY CHANGE
RESPONSIBILITY CHANGE
'CHECK
BCBS
P AY MENT
BCBS ADJUSTMENT
RESPONSIBILITY CHANGE
RESPONSIBILITY
CHANGE
*CHECK
10/08/2013
10/30/2013
10/30/2013
10/31/2013
10/31/2013
02/10/2014
10/08/2013
10/30/2013
10/30/2013
10/31/2013
10/31/2013
02/10/2014
BCPMT
BCADJ
RESP
RESP
CHECK
BCPMT
BCADJ
RESP
RESP
CHECK
SIOUXLAND OBSTE TRIC
130.0
84.8
24.0
21.2
21.2
-21.20
294.0
220.0
19.0
55.0
55.0
-3.8
C P T only
©2000
American
Medical Association. All Rights
reserved.
AcctDtt. rpt
V e r
8.2.0 landscape
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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rinted: 09/16/2014 12:16 PM
ser: MT A Y L O R
Primary
Insurance
Policy
for th is
Encounter:
Plan Code
BCBS1
Policy*: HSV80762H51
Holder: MICHELLE
A BIRD
Relationship to
Holder:
SELF
Effective Date:
Policy
Holder
Employer : None
SIOUXLAND OBGYN
PC
ACCOUNT
DETAIL
REPORT
Plan Name
:
Group :
Group Name
:
Expiration Date:
BCBS OF IOWA
Enc.
Date: 02/10/2014
Enc.
:
Billing Provider: 2-EASTMAN,
MD, PAUL
J
70350
Enc.
Post
Date:
03/05/2014 Loc
Examining
Provider:
2-EASTMAN, MD,
PAUL
J
Referring Provider:
SIOUXLAND OBSTETRICS
Primary Diagnosis
for this Encounter
02/10/2014
03/05/2014
03/05/2014
03/05/2014
03/05/2014
BCPMT
BCAOJ
RESP
RESP
BCBS
PAYMENT
BCBS
ADJUSTMENT
RESPONSIBILITY
CHANGE
RESPONSIBILITY
CHANGE
274.00
0.00
14.00
260.00
260.00
Primary
Insurance
Policy
for
this
Encounter:
Plan Code
BCBS1
Policy*: HSV807621451
Holder: MICHELLE A. BIRD
Relationship to
Holder:
SELF
Effective Date:
Policy Holder Employer: None
Plan
Name
:
Group
:
Group
Name
:
Expiration
Date:
BCBS
O F IOWA
Enc. Date: 11/13/2013
Enc.
:
Billing Provider:
2-EASTMAN,
MD,
PAUL
J
6 5
Enc.
Post
Date:
12/10/2013
Loc:
Examining
Provider: 2-EASTMAN,
MD, PAUL J Referring
Provider:
SIOUXLAND
OBSTETRIC
Primary D iagnosis
for
this
En counter
11/13/2013
12/04/2013
12/04/2013
12/10/2013
12/10/2013
BCPMT
BCADJ
RESP
RESP
BCBS
PAYMENT
BCBS
ADJUSTMENT
RESPONSIBILITY CHANGE
RESPONSIBILITY CHANGE
721.00
497.60
99.00
124.40
124.40
Primary
Insurance
Policy
for
th is
Encounter:
Plan
Code
BCB51
Policy
: HSV80762H51
Holder: MICHELLE
A.
BIRD
Relationship to
Holder: SELF
Effective
Date;
Plan Name
:
Group
:
Group
Name
:
Expiration D ate:
BCBS
O F IOWA
CPT
only
©2000
A mer ican
Medical
A ssociation Ail
Rights reserved
AcctDtl.rpt Ve r 8.2.0
Landscape
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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IN THE
IOWA DISTRICT COURT
FOR SAC
COUNTY
SMALL CLAIMS DIVISION
L F
NOLL
INC
PLAINTIFF
VS
NO
MICHELLE A BIRD
ROBERT
BIRD
SR.
DEFENDANT(S)
VERIFICATION OF ACCOUNT
IDENTIFICATION
OF
JUDGMENT
DEBTOR AND CERTIFICATE RE
MILITARY SERVICE
For Defendant: ROBERT BIRD SR.
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 true
copy of the original creditor s records showing the balance due is true and correct. I further state that the sum
of
846.40 is the balance due and owing as of NOVEMBER 24, 2014 from Defendant(s) to Plaintiff s) and an
interest amount owing
is
accurately stated
in the
Petition
and
Original Notice.
2.
I further state that Defendant,
ROBERT BIRD SR.,
resides at 501 S
MAIN
ST PO BOX 407 ODEBOLT IA
51458-0407.
is employed at , 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 States government, I have verified this fa
by (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/appj/scra/scraHome.do.
Contacting Defendant wh o informed me, or
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 military
service
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 and
correct
L.F. NOLL, INC.
T.
L NOLL, VICE PRESIDENT
70 5
Douglas St., Suite
34 4
Sioux City, IA51101
712-252-0583
0002973482
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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NCS,
IKC
DBA
NOLL
COLLECTION
SERVICE
705
DOUGLAS STHEET, SUITE
344
PO
BOX 59 3
STOUX CITY
TA
5 , 102-0593
712)252-0583
NOVEMBER 4,
2014
YICHELLE A BIRD
ROBERT
BIRD SR
301 S M A I N ST
PO BOX 407
ODE3CLT 1A 514580407
You are now in defau lt on t is credit transaction.
You
have a right, to
correct t h i s default w i t h i n
20
days.
If you do sc, you nay cor.r.ir.ue witr.
rhc
contract as though you did not
default.
YOUR DEFAULT CONSISTS OF : FATLURE TO PAY AS AGRE.-ID
If you
do not
correct. t h l s
default w i t h i n 20
days,
we may
exercise our
r i g h t s against you under the law.
It
you
default again
in the
next year,
we may
exercise
our ri ghts
wiihou'
sendin g
yo u another notice like this one. If you have any ques tions, wri~e c.
telephone promptly.
C
n
ient Ref No Pri ncipal Interest Other
SiOUXLAND (JROLO
00423848 388.80 7.14
SFOUXLAND
OBSTE 44734 435.60 14.86
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
http://slidepdf.com/reader/full/scsc015550-judgment-against-odebolt-couple-in-the-amount-82400pdf 13/20
NCS,
INC DBA
NOLL COLLECTION SERVICE
A Professional Debt Collection Service Since 1965
70S
DOUGLAS STREET, SUITE 344
SIOUX CITY, IA 51101
(712)
252-0583
DATE:
OCTOBER 24,
2014
SIOUXLAND UROLOGY
ASSOCIATES 025500
P O BOX
2020
NORTH SIOUX CITY
SD
570492020
ATTENTION:
RE:
MICHELLE A BIRD
00423848 $388.80 04/18/14
The 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 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
SUIT
For valuable consideration, receipt hereby acknowledged,
the
undersigned hereby
assign, transfer, and set
over
unto L.F.
Noll, Inc. that
certain
claim
against
MICHELLE
A
BIRD
ROBERT BIRD
SR
for
goods, wares and merchandise sold and delivered or services rendered and
performed
in the principal
amount
of $388.80
plus
lawful interest
thereon; and does hereby authorize said assignee to do and perform all acts
necessary for collection; commencement of suit in the name of the assignee,
settlement,
adjustment, compromise or satisfaction of said claim. Assignor
hereby certifies that said claim is justly due and owing and
warrants
compliance
with requirements of the Iowa Consumer Credit Code as well as
disclosure
and
other provisions
of
truth
in
lending,
and
that same
is
free
of
set-offs and other defenses.
Dated this f
/ day of
CS fr A.
, 2 _
SIOUXLAND
UROLOGY
ASSOCIATI
By:
THIS IS AN ATTEMPT TO COLLECT A DEBT,
INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
0002960040
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
http://slidepdf.com/reader/full/scsc015550-judgment-against-odebolt-couple-in-the-amount-82400pdf 14/20
Account Ledger
Box 2020
Dunes, SD 57049
(6 0 5 )2 1 7 -7 0 1 0
IA 51458
Phone (712) 490-684
Phone
Patient Balance
Insurance Pending
0 3
3 684^
Total Current
$22.80
$0.00
$117.00 $0.00
2 5 7 - J O - r
1 0 9
0 0
-
:count:
00423848
22 80^
ssponsible
Party:
Self
urance
1
(HSV807621451) BCBS Iowa Wellmark
5 3 8 • 8 0 *
primary
Provider:
(18)
Andrew
Bourne
Referring
Physician: (924)
Shelly Else
Account Balance
11030 31 to 60 61 to 90 91 to 120 121 to 150
$0.00 $0.00 $0.00 $0.00 $22.80
$117.00 $0.00 $0.00 $0.00 $0.00
Ove
Provider
Bill
Status Service Date Code
Description Charge
Payment
Ad
Bourne
I (18) Bourne
A
(18) Bourne
A
(18) Bourne
Bourne
(18)
Bourne
A (18) Bourne
A (18) Bourne
M Memo
M
Memo
Entry Date: 10/02/20 13
(16)
Kassin
PA-C
I
(16) Kass in PA-C
A
(16) Kassin PA-C
A (16) Kassin PA-C
M Memo
M Memo
Entry
Date:
12/17/2013
(18) Bourne
I (18) Bourne
A
(18) Bourne
M Memo
M Memo
Entry Date: 05/22/2014
(18)
Bourne
M Memo
Entry Date: 10/17/201 4
Bill
09/26 /201309/26 /2013 $285.00
Bill
10/21/2013 10/21/2013
3 0
BCBS Iowa Weiimark
0034236410
Bill 10/21/2013 10/21/2013 C045
0
Charges exceed contracted
fee
schedule
Bill 04/17/2014 04/17/201 4
C 0 Collection Write O ff
Bill 09/26/201309/26/2013 $158.00
Bill 10/21/2013 10/21/2013 3 0 BCBS Iowa Wellmark
0034236410
Bill 10/21/2013 10/21/2013 CO45 0 Charges exceed contracted fee
schedule
Bill 04/17/2014 04/17 /201 4 C 0 Collection Write Off
10/02/2013 Ins
Code
sequence on visit [3]; by
user:
DBertrand
10/21/2013
$366 .00 applied
to deductible.
Visit Balance: $0.00 $443.00 $0.00
Bill 12/05 /20131 2/05/201 3 $117.00
Bill
01/14/201401/14/2014 3 0 BCBS
Iowa
Weiimark
($91.20)
0034253558
Bill 01/14/2014 01/14 /2014 CO45
0
Charges exceed contracted
fee
schedule
Bill
04/17/2014 04/17/2014
C 0
Collection
Write Off
12/17/2013 Ins
Code
sequence on visit [3]; by user:
DBertrand
01/14/2014 $22.80 appl ied
to co-payment.
Visit Balance: $0.00 $1 1 7.00 ($91 20 )
Bil l 05/08/201 405/08/20 14 $117.00
Bill 06/1 6/20 14 06/16/2014
3 0
BCBS Iowa Wellmark ($91.20)
0034283500
Bill 06/16/2014 06/16/20 14 CO45
0
Charges exceed contracted
fe e
schedule
05/22/2014
Ins
Code sequence
on
visit
[3]; by
user:
DBertrand
06/1 6/201
4
$22.80 appl ied
t o
co-payment.
Visit Balance: $22 .80 $117.00 ($91.20)
No
Bill
10/09/2014 10/09/2014 $117.00
10/17/2014 Ins Code sequence on visi t [3]; by user:
DBertrand
Visit Balance: $117.00 $117.00 $0.00
($
($2
($
( $ 1
($4
(
($
($
(
(
Bill:
22.80
No-Bill: 117.00
Total : 139.80
794.00 ( 182.40)
= Charge; I = Insurance Payment; P = Private Payment; A = Adjustment; F = Insurance Filing; M = Memo
All Visits
a
preliminary (open) transaction
that is
subject
to
review.
4
AM
Created
by: RTorres
ID:
17 Ver
1.15.2.9
Page
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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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
1 0 / 2 1 /2 0 1 4 0 9 : 2 0
5 5 6
P . 0 0 2 / 0 0
NCS,
INC DBA
NOLL COLLECTION SERVICE
A
Professional Debt Collection Service Since 1965
705 DOUGLAS STREET, SUITE 344
SIOUX CITY, IA 51101
(712) 252-0583
DATE:
OCTOBER 24, 2014
SIOUXLAND OBSTETRICS
026122
GYNECOLOGY
PC
2730 PIERCE ST SUITS 201
SIOUX
CITY,
IA 51104
ATTENTION:
RE: MICHELLE A
3IRD
44734 S435.6G 10/17/14
The above debtor refuses to cooperate. We recommend further action, in
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)
* Tf the
original account
is a
contract
or
note,
we
must have
the
original.
Please
return promptly. Court costs will be advanced on your behalf.
not: accept payments
or
make arr angements, without calling
us
first.
THANK
YOU
FOR YOUR
COOPERATION
ASSIGNMENT FOR PURPOSES OF SUIT
consideration, receipt hereby acknowledged, the undersigned hereby
transfer, and set over unto L.F. Noll, Inc.
that
certain claim against
MICHELLE A BIRD
ROBERT BIRD
SR
goods, wares and merchandise sold and delivered or services rendered and
principal amount
of
S435.60 plus lawful interest
es hereby authorize said assignee to do and perform all acts
for
collection; commencement
of
suit
in the
name
of the
assignee,
, compromise or satisfaction of said claim. Assignor
certifies that said claim is justly due and owing and warrants
and
ether provisions
of
truth
in
lending,
and
that same
is
free
of
and other defenses.
this
f y of
OBSTETRICS &
:
(Xame
and Official
title)
THIS
IS AN
ATTEMPT
TO
COLLECT
A
DEBT,
INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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Printed:
09/16/2014 12:16 PM
User :
M T Y l
O R
Financial Group: 2-SIOUXLAND OBGYN PC SIOUX CITY
Guar : 44734
Guar: MICHELLE
A.
BIRD
Findass: PRIVATE
PAY
Guarantor A d d r e s s :
c U
501 S
MAIN
ST
PO
BOX 407
ODEBOLT,
IA
51458
Home: (712)210-3539
Work:
Guarantor
Employer:
None
i r
O K to
SIOUXLAND
OBGYN PC
ACCOUNT
DETAIL
REPORT
Guar
Account Balance: $ 435 60
0 - 30
days
:
0.00
31 to
60
days: 0.00
61 to 90 days : 0.00
91 to 120 days: 0.00
121 to
150 days 0.00
Over
150
days: 435.60
Last Statement Date:
04/30/2014
Patient*:
45733 Patient Balance:
Patient: MICHELLE
A.
BIRD
Patient Address:
501 S
MAIN
ST
PO
BOX 407
ODEBOLT, IA
51458
435 60 Insurance Balance: 0.00 Collection Balance: $
Home:
(712)
210-3539
Work:
(712)
-
Patient
Employer:
None
Enc.
Date:
10/08/2013
Enc.
:
61917 Enc.
Post
Date: 02/12/2014
Loc:
SIOUXLAND
OBSTETRIC
Billing Provider:
2-EASTMAN MD PAUL J
Primary
Diagnosis
for this Encounter:
Examining
Provider: 2-EASTMAN MD PAUL J Referring Provider:
BCBS PAYMENT
BCBS ADJUSTMENT
RESPONSIBILITY CHANGE
RESPONSIBILITY CHANGE
CHECK
BCBS PAYM ENT
BCBS
ADJUSTMENT
RESPONSIBILITY
CHANGE
RESPONSIBILITY CHANGE
•CHECK
10/08/2013
10/30/2013
10/30/2013
10/31/2013
10/31/2013
02/10/2014
10/08/2013
10/30/2013
10/30/2013
10/31/2013
10/31/2013
02/10/2014
BCPMT
BCADJ
RESP
RESP
CHECK
BCPMT
BCADJ
RESP
RESP
CHECK
130 00
84 80
24 0
21 2
21 20
21 2
294
•220 00
19 00
55 00
55 00
3 80
C P T only©2COO A merican Medical Association. All Rights reserved.
AcctDtl.rpt
V e r
8.2.0 andscape
E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
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Printed; 09/16/2014 12:16 PM
User: M T Y L O R
Primary
Insurance Policy
for this
Encounter:
Plan Code
BCBS1
Poh cyi : HSV807621451
Holder:
MICHELLE A. BIRD
Relationship to Holder: SELF
Effective Date:
Policy
Holder
Employer : None
SIOUXLAND OBGYN PC
ACCOUNT DETAIL
REPORT
Plan
Name :
Group :
Group Name :
Expiration
Date:
BCBS OF IOWA
Enc. Date: 02/10/2014 Enc.
:
70350 Enc. Post Date:
03/05/2014 Loc:
SIOUXLAND OBSTETRI
Billing
Provider: 2-EASTMAN MD, PAULJ Examining Provider: 2-EASTMAN MD, PAUL J Referring Provider:
Primary Dagnosis
for this
Encounter:
02/10/2014
03/05/2014
03/05/2014
03/05/2014
03/05/2014
BCPMT
BCADJ
RESP
RESP
BCBS
PAYMENT
BCBS ADJUSTMENT
RESPONSIBILITY
CHANGE
RESPONSIBILITY C HANGE
274.0
0.0
14 00
260 00
260 0
Primary
Insurance Policy
for
th is
Encounter:
Plan Code BCBS1
Policy
:
HSV807621451
Holder: MICHELLE A. BIRD
Relationship
to Holder: SELF
Effective Date:
Policy Holder
Employer :
None
Plan Name
:
Group
:
Group Name
Expiration
Date:
BCBS O F IOWA
Enc. Date: 11/13/2013 Enc.
:
Billing Provider:
2-EASTMAN
MD
PAUL J
64451
Enc. Post Date: 12/10/2013
Examining Provider: 2-EASTMAN MD, PAUL 3 Referring Provider:
Loc:
SIOUXLAND OBSTETRIC
Primary
Diagnosis
for this
Encounter:
11/13/2013
12/04/2013
12/04/2013
12/10/2013
12/10/2013
BCPMT
BCADJ
RESP
RESP
BCBS
PAYMENT
BCBS
ADJUSTMENT
RESPONSIBILITY
CHANGE
RESPONSIBILITY CHANGE
721 0
497 60
99 00
124 40
124 4
Primary
Insurance Policy
for
this
Encounter:
Plan Code BCBS1
Policy*: HSV807621451
Holder: MICHELLE
A .
BIRD
Relationship to
Holder: SELF
Effective
Date:
Plan Name
:
Group :
Group
Name
:
Expiration Date:
BCBS OF IOWA
CPT
ony
©2000
Ame rican Medical As sociation. All
Rights
reserved.
AcctDtl.rpt Ver
8.2.0
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E-FILED 2014 DEC 02 1:23 PM SAC - CLERK OF DISTRICT COURT
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E-FILED 2014 DEC 19 10:56 AM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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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 SCSC015550
vs.
JUDGMENT ENTRYDefendant(s),
MICHELLE BIRD501 S MAIN STREETODEBOLT IA 51458
ROBERT BIRD SR501 S MAIN STREETODEBOLT IA 51458
The court file shows that the defendants have received proper notice and have 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 defendants, jointly and severally, in the amount of $ 824.40 with interest at the rate of 2.13 % from the 2nd day of December, 2014 and court costs. The Court further enters judgment for prejudgment interest in the amount of $22.00.
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: $850.00
1 of 2
E-FILED 2014 DEC 30 9:11 PM SAC - CLERK OF DISTRICT COURT
8/9/2019 SCSC015550 - Judgment against Odebolt couple in the amount $824.00.pdf
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State of Iowa Courts
Case Number Case TitleSCSC015550 L.F. NOLL, INC. V BIRD, MICHELLE AND ROBERT SR.Type: ORDER FOR JUDGMENT
So Ordered
Electronically signed on 2014-12-30 21:10:55
E-FILED 2014 DEC 30 9:11 PM SAC - CLERK OF DISTRICT COURT