SCSC015555 - Judgment Against Sac City Couple in The Amount $904.05 PDF

E-FILED 2014 DEC 17 3:40 PM SAC - CLERK OF DISTRICT COURT
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
ORIGINAL NOTICE AND PETITION
FOR A MONEY JUDGMENT
VS
DUSTIN J. SANDERS
225S11THST
SAC CITY IA 50583-2020
NO.
ANGELA SANDERS
225S11THST
SAC CITY IA 50583-2020
DEFENDANT(S)
To Defendant(s):
1. You are notified that the above-named Plaintiff demands of you the amount of $929.59. This claim is
based on the value of goods and/or services supplied by the following persons or businesses in the amounts
indicated below. Said claims are assigned to Plaintiff.
CREDITOR
LORING HOSPITAL
PRINCIPAL
$904.05
PRE-FILING INTEREST
$25.54
2 Judgment may be entered against you unless you file an Appearance and Answer within 20 days of the
service of the Original Notice upon you. Judgment may include the amount requested plus interest and court
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 you obtain from
the court an exemption from electronic filing requirements.
4 If your Appearance and Answer is filed within 20 days and you deny the claim, you will receive
electronic 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 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 must also notify the clerk's office of any address change.
iSICAR. NOLLAT0008873
705 Douglas St., Ste 502
Sioux City IA 51101
Phone (712) 224-2675
Fax (712) 252-4497
jrn@decklaw.net
ATTORNEY FOR PLAINTIFF
0002966977
DECEMBER 16,2014

L. F. NOLL, INC.
PLAINTIFF
VERIFICATION OF ACCOUNT
IDENTIFICATION OF JUDGMENT
DEBTOR AND CERTIFICATE RE
MILITARY SERVICE
VS
DUSTIN J. SANDERS
ANGELA SANDERS
DEFENDANT(S)
NO.
For Defendant: ANGELA SANDERS
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 $929.59 is the balance due and owing as of DECEMBER 16, 2014 from Defendant(s) to Plaintiff(s) and any
interest amount owing is accurately stated in the Petition and Original Notice.
2 I further state that Defendant, ANGELA SANDERS, resides at 225 S 11TH ST SAC CITY IA 50583-2020. 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 fact
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/appi/scra/scraHome.do.
Contacting Defendant who 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.
TrlTNOLL, VICE PRESIDENT

705 Douglas St., Suite 344
Sioux City, IA51101
712-252-0583
0002966977
Creditor: I.ORINU110SHIAI
E-FILED 2014 DEC 17 3:40 PM SAC -Account

CLERK
OF DISTRICT COURT
#i <Hio:%?-t:^
|
Amount Due:
W29..S9
| Amount In Default:
y>2').5V
~>
PAY THIS AMOUNT
^
f
^
THIS ACCOUNT HAS BEEN LISTED WITH OUR AGENCY FOR

COLLECTION.
]
J
DE.AR DUS !'IN J SANDERS & ANGELA SANDERS,

YOU -\RE IN DEFAUl TON THIS CREDIT TRANSAC HON. YOU H A V E A RIGHT TO COR R 1C I THIS
DTFAULT. IE YOU DO SO. YOU MAY CONTINUE WITH THE CON TRACT AS THOUGH YOU DID
NO I DEFAULT.
YOUR DEFAULT CONSISTS OF: I A I E U R E TO PAY AS AGREI-.D
CORRECT THIS DEFAULT BY: PAYING. THE: AMOUNT IN DEFAULT. W2<>.5<> TO NOLL
COLLECTION SERVICE. AGENT FOR TUT: ABOVE CREDITOR.
IE YOU DO NOT CORRECT 'THIS DEFAULT WITHIN 30 DAYS. WE MAY EXERCISE OUR RIGHTS
AGAINST' YOU UNDER THE: LAW.
IE YOU DEFAULT AGAIN WITHIN THE N E X T Y F A R . \V|- MAY EXERCISE OUR RIGHTS WITHOUT
SENDING YOU ANOTHER NOTICE L I K E ' T H I S ONE:. IF YOU' HAVE ANY QUESTIONS, \ \ R I T F OR
TELEPHONE PROMPTLY.
UNLESS YOU DISPUTE: THE. VALIDITY OF THE DEBT OR ANY PORTION THEREOF. WITHIN 30
DAYS AFTER RECEIPT OE THIS NOTICE. WE SHALE ASSUME. I HE DEBT TO BE VALID. IT YOU
NOTIFY US IN WRITING OE YOUR DISPUTE WITHIN TIMS 30 DAY PERIOD. WE WILE OBTAIN
VERIFICATION OF TUT DEBT AND WILL MAIL YOU A COPY. UPON YOUR WRITTEN REOU1.S [
WITHIN A THIRTY DAY PERIOD Wl Wll L PROVIDE YOU W I T H Till- N A M E AND AN ADDRESS
OF THE ORIGINAL CREDITOR IF DIFFERENT FROM T H E CUR R I-NT CR EDI I OR.
SINCERELY.
NO1 L COLLECTION SERVICE
We offer convenient Payment Options
M;iil payment in
enclosed em elope
Pay online:
.nc^foIlecls.com
THIS IS AN ATTEMPT TO COLLECT A DEBT,

A N Y I N F O R M A T I O N OBTAINED W I L E BE USED FOR THAT PURPOSE.
V
s. I n - . '115 ] 1 ( ) [ CM .\ S 1 K I - I I. SI i l l .-44. S I O U X C I I ' Y IA <i I 1 1 ) 1 . P H ' ( 7 1 2) 2?2-t)^. I AX
[ ' I 2 ) O '- i - V 4 I M . h m . n l n i . n l
IF PAVING BY CREDIT CARD. PLEASE FILL OUT BELOW

VISA
Personal & (.'imfldi'titiul
DUSTIN J S A N D I R S
ANdl I.A SANDFRS
225 S I I T H S T
SAC CITY. IA 505X3-2020
NCS IN( (
IH) BOX ^jl
SIOUX CITY IA 51
E-FILED 2014 DECNCS,

17 3:40
PMDBA
SAC - CLERK OF DISTRICT COURT
INC
NOLL COLLECTION SERVICE
ofessior.al Cebt Collection Service Since 1965"
^05 DOUGLAS STREET, SUITE 344
SIO'JX CITY, IA 511C1
(i:2} 252-0533
A?.A:5A?,-THC:-:P50:;,S
563318
3904. Ob
36/17/14
Trie above debtor refuses to cooperate- >.;e recommend further action, in
rder to enforce collection. Before cur attorney can proceed, we will require
" Completion of the assignment at the bottom of this pa ye.
* CoP'^' of tPIG i tsmizsd state m.ent shc>-:ino ba 1 ance due [if not
previously provided)
* If the original account is a contract or note, we must nave the
AS S 13 \''".-'; E N" T FOR PURPOSES OF SUIT
"or valuable oonsideratior., receipt hereby acknowledged, the undersigned here:

assign, transfer, and set over untc L.F. N'oll, Inc. that certain clairri agains 1
DUSTIN J SANDERS
ANGELA SANDERS
for gocas, wares and merchandise sold and delivered or services rendered and
performed in the principal amount of$9C4.05 plus lawful interest
thereon; and does hereby authorize said assignee to do and perform all aots
necessary for c"l". ecv.ion; commencement of suit in the name of the assignee,
settlement, acr usfment, compromise or satisfaction of saia claim. Assignor
hereby certifies than saia claim is yustly due and owing and waBrants
oorcl-anoe v:ith reouiremenfs of the Iowa Consumer Credit Code as well as
.
li&LprVXyvo QuAi/YUA6
'Name and Official Title)
f -
ELEPHONE
NO.
lorintj
Hospital
E-FILED 2014 DEC 17
3:40 PM
SAC - CLERK OF DISTRICT
COURT
DOCTOR
GYANO,
B.
712-662-4008
K.
MED. REC. NO. / ADMISSION NO.
BILLING DATE
11/08/13
34226
211 Highland Ave Sac City, IA 50583
PAGE
POLICY HOLDER
POLICY NUMBER
INSURANCE COMPANY
NO
KHIAN4896757
SANDERS, DUSTIN
SELF-PAY
111111111
BARAIBAR-THOMPS
PATIENT NAME
GUARANTOR
DUSTIN
PATIENT
TYPE
225 S 11TH STREET

SAC CITY IA 50583
15
34226 /
ADMISSION DATE DISCHARGE DATE

10/20/13
BIRTHDATE
10/25/13
DESCRIPTION
QUANTITY
CHARGE
CPT
204 .000
204. 000
204 . 000
AMOUNT
204.00
DEPT TOTAL
204 . 00
1224 . 00
DEPT TOTAL.
18 . 00
44 . 00
62 . 00
18.000
44 .000
PHARMACY
PAY LAST
BALANCE
204.00
204 .000
340
340
340
340
340
340
AGE
204.00
204.000
LABORATORY
SEX
204 . 00
204 . 00
204.000
INFUSION/CHEMO THE
563318
11
GUARANTOR IS RESPONSIBLE FOR ANY AMOUNTS DUE AFTER THE INSURANCE COMPANIES MAKE THEIR PAYMENTS
CHARGE
CODE
563318
S BARAIBARTHOMPSO
SANDERS
PLAN
BLUE CROSS 140
DATE
EXTENSION
820
820
820
820
820
820
000
000
000
000
000
000
000
000
000
000
000
000
340.82
340 .82
340 . 82
340 . 82
340.82
340.82
8 . 00
8 . 00
8 . 00
8 . 00
8 . 00
8 .00
DEPT TOTAL
8 . 00
8.00
8 . 00
8 . 00
8 . 00
8 . 00
2140 . 92
DOCTOR
Loiing Hospital
GYANO , B . K .
BILLING DATE
11/08/13
NO
712-662-4008
MED. REC. NO. I ADMISSION NO.
PAGE
POLICY NUMBER
INSURANCE COMPANY
07 BLUE CROSS 140

05 SELF-PAY
KHIAN4896757
111111111
34226
PATIFNT
TYPE
225 S 11TH STREET

SAC CITY IA 50533
15
MED. REC. NO. / ADMISSION NO
10/20/13
34226 /
BIRTHDATE
10/25/13
DESCRIPTION
QUANTITY
CHARGE
SUMMARY OF CHARGES
INFUSION/CHEMO THERAPY
LABORATORY
PHARMACY
1224 . 00
62 . 00
2140.92
TOTAL CHARGES
3426.92
BALANCE
563318
SEX
AGE
11
CHARGE
CODE
563318
SANDERS, DUSTIN
BARAIBAR-THOMPS
S BARAIBARTHOMPSO
DUSTIN SANDERS
PLAN
POLICY HOLDER
PATIENT NAME
GUARANTOR
DATE
EXTENSION
TELEPHONE NO.
E-FILED 2014 DEC 17 3:40 PM SAC - CLERK OF DISTRICT
COURT
CRT
PAY LAST
BALANCE
AMOUNT
3 4 2 6 . 92
E-FILED 2014 DEC 17

3:40 PM
COURTNO.
Lorin#
Hospital
TELEPHONE
DOCTOR
GYANO,
712-662-4008
B. K .
BILLING DATE
10/31/13
34226 /
21 1 Highland Ave Sac City, IA 50583
PAGE
INSURANCE COMPANY
NO
EXTENSION
BLUE CROSS 140

SELF-PAY
POLICY HOLDER
POLICY NUMBER
KHIAN4896757
111111111
PLAN
SANDERS, DUSTIN
BARAIBAR-THOMPS
PATIENT NAME
GUARANTOR
DUSTIN SANDERS
S BARAIBARTHOMPSO
PATIENT
TYPE
225 S 11TH STREET

SAC CITY IA 50583
13
34226 /
10/18/13
BIRTHDATE
10/19/13
CHARGE
DATE
DESCRIPTION
QUANTITY
CHARGE
CPT
CODE
10-18
1
550.000
OBSERVATION
SEX
AGE
11
PAY LAST
BALANCE
AMOUNT
550.00
550.00
DEPT TOTAL
288 . 00
72.00
114.00
204.00
204.00
67 . 00
108.00
378.00
378 .00
1813.00
18.000
18 ,000
18 . 000
36,240
85.000
17 . 720
44. 000
44 .000
57 . 680
57.680
91.000
91.000
3 8 . 4 8 Oi
DEPT TOTAL
18 . 00
18 . 00
18 . 00
36.24
85 . 00
17.72
44 . 00
44 . 00
57 . 68
57.68
91. 00
91.00
38 .48
616 . 80
72
72
114
204
204
67
54
54
54
000
000
000
000
000
000
000
000
000
INFUSION/CHEMO THE
10-18
02
563301
DEPT TOTAL
ROOM
LABORATORY
563301
16.250
REFERRAL LABORATOR
DEPT TOTAL
10 . 000
10.000
10.000
23.410
23.410
107 .930
107 . 930
16.25
16 .25
10. 00
10. 00
10 . 00
46 . 82
23 .41
215 .86
107.93
Hospital
;LEPHQNE
NO.
E-FILED 2014 DEC Loring
17 3:40 PM
COURT
DOCTOR
GYANO, B . K .
712-662-4008
BILLING DATE
10/31/13
NO
MED. REG. NO. / ADMISSION NO,
PAGE

POLICY NUMBER
INSURANCE COMPANY
BLUE CROSS
SELF-PAY
GUARANTOR
DUSTIN
KHIAN4896757
111111111
140
34226 /
POLICY HOLDER
PATIENT
TYPE
13
SANDERS, DUSTIN
BARAIBAR-THOMPS
MED. REC. NO, / ADMISSION NO

34226 / 563301

10/18/13
BIRTHDATE
10/19/13
DESCRIPTION
QUANTITY
CHARGE
CPT
98 . 880
98 . 880
98.880
106.250
267.020
340.820
340 . 820
2 . 390
8 . 000
PHARMACY
10-18
DEPT TOTAL
50.011
RADIOLOGY, PROFESS
10-18
10-18
10-18
10-18
10-19
10-18
10-19
10-18
10-19
AMOUNT
98 . 88
98 . 88
98 . 88
106 .25
267.02
340 .82
340 .82
2 .39
8 .00
1785.96
DEPT TOTAL
148 .50
148 . 50
DEPT TOTAL
19.80
16 . 34
17.41
17 .41
70 . 96
DEPT TOTAL
125.00
125.00
97 . 00
194.00
541.00
125 . 000
125 . 000
97 . 000
97.000
RESPIRATORY THERAP
PAY LAST
BALANCE
50 . 01
50 .01
19.800
16.340
17.410
17 .410
IV SOLUTIONS
AGE
DEPT TOTAL
148.500
RADIOLOGY, TECH
SEX
11
CHARGE
CODE
563301
PLAN
PATIENT NAME
S BARAIBARTHOMPSO
SANDERS
225 S 11TH STREET

SAC CITY IA 50583
DATE
EXTENSION
DOCTOR
GYANO,
Lorin# Hospital
TELEPHONE NO.
E-FILED 2014 DEC 17 3:40 PM SAC - CLERK OF DISTRICT
COURT
B. K .
BILLING DATE
10/31/13
NO.
PAGE
07 BLUE CROSS
05 SELF-PAY
27 T Highland Ave Sac City, IA 50563
INSURANCE COMPANY
POLICY NUMBER
140
34226 /
POLICY HOLDER
KHIAN4896757
111111111
GUARANTOR
SANDERS, DUSTIN
BARAIBAR-THOMPS
S BARAIBARTHOMPSO
11TH STREET
P TYPE NT
IA 5 0 5 8 3
13
SAC CITY
34226 /
10/18/13
10/19/13
DATE
DESCRIPTION
CRT
QUANTITY
SUMMARY OF CHARGES
OBSERVATION ROOM
LABORATORY
REFERRAL LABORATORY
PHARMACY
RADIOLOGY, PROFESSIONAL
RADIOLOGY, TECH
IV SOLUTIONS
RESPIRATORY THERAPY
550.00
1813 . 0 0
616 . 8 0
16.25
1785.96
50.01
148 . 50
70.96
541.00
TOTAL CHARGES
5592 . 4 8
BALANCE
u-R-13
C*
11
^^V$ IÎBn^^M
AMOUNT
5592 . 4 8
^Su^- SêA
frtfA
563301
BIRTHDATE j SEX AGE
^t^/02 F
G U A R A N T O R IS RESPONSIBLE FOR ANY AMOUNTS DUE AFTER THE INSURANCE COMPANIES M A K E THEIR PAYMENTS
CHARGE
CODE
563301
PLAN
PATIENT NAME
DUSTIN SANDERS
225
?b
Vs-"
^>f
f\
EXTENSION
712-662-4008
s<^^\> &>
H.as"
31. B(
"BWX
u-iq~\
C/\
4.15
N
\E
l^n^.S"/
3^^^-â
S^^-^ 3
\l
DOCTOR
LANKFORD , TONYA
TP r
/\
NO.
PAGE
INSURANCE COMPANY
07
BLUE CROSS
05
SELF-PAY
POLICY NUMBER
140
30756
POLICY HOLDER
KHIAN4896757
SANDERS,
DUSTIN
SANDERS,
DUSTIN
PATIENT NAME
DUSTIN SANDERS
S
11TH STREET
P TYPE NT
26
30756

10/09/13
BIRTHDATE
10/09/13
CHARGE
CODE
10-09
10-09
10-09
DESCRIPTION
sssr*
QUANTITY
562814
SEX AGE
W/83 M
DATE
562814
DUSTIN SANDERS
SAC CITY IA 5 0 5 8 3
PLAN
HftS926
GUARANTOR
225
EXTENSION
712-299-2998
<>-v
BILLING DATE
10/17/13
Lorin#
Hospital
'ELEPHONE
NO.
E-FILED 2014 DEC 17
3:40 PM
COURT
PAY LAST
BALANCE
AMOUNT
CRT
18.000
18.00
44 . 000
44 . 00
91. 0 0 0
LABORATORY
91.00
DEPT TOTAL
10-09
RADIOLOGY,
PROFESS
RADIOLOGY,
TECH
1 0 - 0 9 JHBHM
30
50. Oil
DEPT
TOTAL
153 . 00
c\-y
<5o,^ 3^00
**f~^.
148 . 500
t^>
148 . 5 0
DEPT TOTAL
148 . 50
SUMMARY OF CHARGES
LABORATORY
1S3 . 00
RADIOLOGY,
PROFESSIONAL
RADIOLOGY,
TECH
TOTAL CHARGES
3.00
148.50
3 0 4 . 50
BALANCE
304 . 50
\^x>- So>0\A
S^D
4- ^^.c\I
-LH3
Lft
IH./D
31.0(
-3^^
M,-?5.
\E
8<u^
\ ^^n-s-o
#
"i^.S'1^
^3.13
lo.'So
'<U.
tfi.n
Lorincr
Hospital
TELEPHONE
NO.
E-FILED 2014 DEC 17
3:40 PM
COURT
DOCTOR
GYANO,
B. K.
712-299-2998
-.x<
BILLING DATE
12/06/13

PAGE
POLICY NUMBER
INSURANCE COMPANY
NO.
BLUE CROSS
SELF-PAY
KHIAN4896757
4B3926
140
GUARANTOR
30756
POLICY HOLDER
225 S 11TH STREET

SAC CITY IA 50583
20

30756
11/29/13
BiRTHDATE
DESCRIPTION
QUANTITY
CHARGE
CPT
11-29
11-29
SUMMARY OF CHARGES
LABORATORY
REFERRAL LABORATORY
297 .24
61.46
TOTAL CHARGES
358.70
BALANCE
SEX
AGE
30
PAY LAST
BALANCE
AMOUNT
DEPT TOTAL
DEPT TOTAL
30 .73
30 .73
61.46
30 .730
30 .730
REFERRAL LABORATOR
565112
18.00
90.00
44 .00
91.00
54 .24
297.24
18.000
90.000
44 . 000
91. 0 0 0
54 . 2 4 0
LABORATORY
11/29/13
CHARGE
CODE
565112
SANDERS, DUSTIN
SANDERS, DUSTIN
DUSTIN SANDERS
PATIFMT
TYPE
PLAN
PATIENT NAME
DUSTIN SANDERS
DATE
EXTENSION
358 . 70
*&*.!<?
1010-Ob
DOCTOR
E-FILED 2014 DEC 17Lorin#

3:40 PMHospital
COURTNO.
TELEPHONE
GYANO , B . K .
Qf~^
BILLING DATE
/\
11/15/13
NO.
PAGE
518-227-0917
MED.
21 1 Highland Ave Sac City, !A 50583
INSURANCE COMPANY
POLICY NUMBER
07 BLUE CROSS 140

05 SELF -PAY
SANDERS,
SANDERS,
PATIFNT
SAC CITY IA
TYPE
50583
26

30837 /

11/01/13
11/01/13
BIRTHDATE
DATE
11-01
11-01
11-01
^^^B
^M
JMM^fc
DESCRIPTION
QUANTITY
^^BPV
*
HB^k
11-01
WI^Mb
^^f
AMOUNT
18 . 0 0 0
18 . 00
28 . 5 5 0
28.55
44 . 000
RADIOLOGY,
PROFESS
^^^
RADIOLOGY,
TECH
44 . 00
90 .55
50.01
5 0 . Oil
DEPT TOTAL
1
50 . 01
148 . 5 0 0
148 . 50
DEPT TOTAL
SUMMARY OF CHARGES
LABORATORY
^^^MffllSlH^^^H
DEPT TOTAL
4M^M*
RADIOLOGY,
SEX AGE
CRT
LABORATORY
11-01
563957
^/W06 M
CHARGE
CODE
563957
DUSTIN
DUSTIN
DWH^t SANDERS
11TH STREET
PLAN
PATIENT NAME
DUSTIN SANDERS
REC. NO. / ADMISSION NO.
30837
POLICY HOLDER
KHIAN4896757
OMOI5926
GUARANTOR
225
2bf
1 EXTENSION
148 .50
90.55
50.01
148.50
TECH
TOTAL CHARGES
289.06
2 8 9 . 06
BALANCE
^\^\.^^
gem
Q(VO,j)
12-10- /3
4/75"
\
^\E

L. F. NOLL, INC.
PLAINTIFF
VERIFICATION OF ACCOUNT
IDENTIFICATION OF JUDGMENT
DEBTOR AND CERTIFICATE RE
MILITARY SERVICE
VS
NO.
DUSTIN J. SANDERS
ANGELA SANDERS
DEFENDANT(S)
For Defendant: DUSTIN J. SANDERS
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 $929.59 is the balance due and owing as of DECEMBER 16, 2014 from Defendants) to Plaintiff(s) and any
interest amount owing is accurately stated in the Petition and Original Notice.
2. I further state that Defendant, DUSTIN J- SANDERS, resides at 225 S 11TH ST SAC CITY IA 50583-2020.
is employed at KOCH BUSINESS SOLUTIONS 4111 E 37 ST N WICHITA KS 67220. 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 fact
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/appi/scra/scraHome.do.
Contacting Defendant who 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,
T. JXNOLL, VIC&^RESIDENT
705 Douglas St., Suite 344
Sioux City, IA51101
712-252-0583
0002966977
LORINUHOSPI'IAL
Creditor:
E-FILED 2014 DEC 17 3:40 |

PM SAC - CLERK
DISTRICT COURT
<Jfl2%M25
Account OF
#:
|
Amount Dot:
S429.59
| Amount In Default:
^29.59
PAY THIS AMOUNT
THIS ACCOUNT HAS BEEN LISTED WITH OUR AGENCY FOR

COLLECTION.
DEAR DUST1N J SANDERS & ANGELA SANDERS.
YOU ARE IN D E F A U L T ON THIS C R E D I T TRANSACTION. YOU I I A V I - A R K i H T TO CORRECT THIS
D E F A U L T . IF YOU DO SO, YOU MAY C O N T I N U E WIT! I T i l l : CONTRACT AS THOUGH YOU DID
NO'I D E F A U L T .
YOUR DEFAULT CONSISTS OF: FAILURE TO PAY AS A G R E E D
CORRECT THIS DEFAULT BY: PAYING THE AMOUNT IN DEFAULT. $929.59 TO NOLI
COLLEC riON S E R V I C E . AGENT FOR THE ABOVE CREDITOR.
IF YOU DO NOT CORRECT TIMS DEFAULT WITHIN 30 DAYS, WE MAY EXERCISE OUR RIGHTS
AGAINST YOU U N D E R THE; L A W .
I F YOU DEFAULT A G A I N W I T H I N THE N E X T Y E A R , WE MAY E X E R C I S E OUR RIGHTS WITHOUT
S E N D I N G YOU ANOTHER NOTICE L I K E T H I S ONE. IF YOU H A V E ANY QUESTIONS. W R I T E OR
T E L E P H O N E PROMPTLY.
UNLESS YOU DISPUTE THE V A L I D I T Y OF THE D E B T O R ANY PORTION THEREOF. W I T H I N 30
DAYS AFTER RECEIPT OF THIS NOTICE, WE SHALL ASSUME THE DEBT TO BE: V A L I D . I F YOU
NOTIFY US IN WRITING OF YOUR DISPUTE W I T H I N THIS 30 DAY PERIOD. WE W I L L O B T A I N
V E R I F I C A T I O N OF THE DEBT AND WILL MAIL YOU A COPY. UPON Y O U R W R I T T E N REO.UEST
WITHIN A THIRTY DAY PERIOD WE WILL PROVIDE YOU WITH Till- N A M E AND AN ADDRESS
O F T i l l - O R I G I N A L C R E D I T O R IF DIFFERENT FROM T i l l - C U R R E N T C R E D I T O R .
SINCERELY,
NOEL COLLECTION S E R V I C E
We offer convenient Payment Options
M
Mail payment in
enclosed envelope
Pay online:
www.ncscollects.L-om
THIS IS AN ATTFMPT TO COLLECT A DEBT,

A N Y INFORMATION OBTAINED W I L L BE USED FOR THAT PI RPOSE.
\ C _ S J n i ; . , _ / O M X : i l . < i L A S S I R I t l j S U l U ' ,"*44. SIO_IJ_X_C_1 !_Y I A _ 5 l l l ) l , I ' l l ' ( 7 1 2)_2S2-<>^K.V [ - A X (712)-2.^-34<M. l-.-unl mnl ( M i i s i o l ^ i N mm
- Plciise Ik-hidi And R c l u r n in ["lie l" n r l i . s i - J I nvdone W i l l i ViHir'l'TivWnl ~-
^JFPAVIIJG BY CREDIT CARP, f LEASJE JF1LL OUT BELOW"

VISA
Personal & Confidential
D L S I I N J SANDKRS
ANGELA SANDERS
225 S NTH SI
SAC CITY. 1A 505X3-2020
NCS INC
i'O BOX 59?
SIOUX CITY 1A 51 102-0593

NCS, INC DBA
NOLL COLLECTION SERVICE
;1 Debt Collection Service Since 1965'
; DCCG-AS STREET, S'JITE 344
; 7 1 2 } 252-0583
_;,-.*- - -^ - v - * w .. - ^ ilj x^ .. i / ^-
- f- o ^ -1 q
^ U ^J O
c; q fi 4 n k
-L
~J Z? <J î * -.J ^s
r '" "' / ~ i
' uJ ' _ - - ' / _ . _ "i
The above debtor refuses to cooperate. We reccmrr.end further action, in

order to enforce collection. 3efore our attorney can proceed, we will require:
* Copy of the itemized statement showing balance due 'if net
c r e v i c u s i y c r c v i d e d)
" If the original account is a contract or none, we must have r.ne
Please return promptly. Court costs will be advanced on your behajf.
^-1 net accepi_ 10ayments or maks arrangements, wioncut ca-. ing us first.
ASSIGNMENT FOR PURPOSES CE S'J!

Ecr valuable consideration, receipt hereby acknowledged, the undersigned hereby
assign, transfer, and set ever unto L.F. Nell, Inc. that certain cla:." against
D'JSTIN J SANDERS
AXGELA SANDERS
for goods, wares and merchandise sold and delivered or services rendered and
cerfcrrr.ed in the principal amount of $904.05 plus lawful interest
~ L-~ ^* -^ &" *" .-^c. does êêov authorize said assignee to QC a~^d oe^"fcr~* ^
~- ^~~ ^
necessary for col.', ection; ccrriêncerr.ent of suit in the name of the assignee,
settlement, acrust~er.t, compromise or satisfaction of said claim. Assignor
nereby certifies that sa id c.âirr. is ~ ustiy due and owing and warrants
corr.ci iance with requirements of the Iowa Consumer Credit Cede as well as
disclosure a n c: other r> r o v i s i o n s of ~ r u t h in lending, and that same is free of
set-c-ifs and otner defenses.
3fr*
0
E-FILED 2014 DEC 17

3:40 PM
COURTNO.
Lorin#
Hospital
ELEPHONE
DOCTOR
712-662-4008
GYANQ , B . K .
MED. REC. NO. / ADMISSION MO.
BILLING DATE
11/08/13
34226 /
211 Highland Ave Sac City, 1A 50533
PAGE
POLICY HOLDER
POLICY NUMBER
INSURANCE COMPANY
NO
EXTENSION
KH1AN4896757
111111111
BLUE CROSS 140

SELF-PAY
PLAN
SANDERS, DUSTIN
BARAIBAR-THOMPS
PATIENT NAME
GUARANTOR
DUSTIN SANDERS
S BARAIBARTHOMPSO
PATIENT
TYPE
225 S 11TH STREET

SAC CITY IA 50583
15
34226 /

10/20/13
B1RTHDATE
10/25/13
DESCRIPTION
QUANTITY
CHARGE
CPT
204.000
204.000
204.000
204.000
340
340
340
340
340
340
PHARMACY
AGE
PAY LAST
BALANCE
AMOUNT
DEPT TOTAL
DEPT TOTAL
18.00
44 . 00
62 . 00
DEPT TOTAL
340.82
340.82
340.82
340.82
340.82
340.82
8,00
8.00
8.00
8 . 00
8.00
8.00
8 . 00
8.00
8 . 00
8 . 00
8 .00
8 .00
2140.92
18.000
44.000
LABORATORY
SEX
204 .00
204 . 00
204.00
204.00
204 . 00
204 .00
1224.00
204 .000
204 .000
INFUSION/CHEMO THE
563318
11
GUARANTOR IS RESPONSIBLE FOR AMY AMOUNTS DUE AFTER THE INSURANCE COMPANIES MAKE THEIR PAYMENTS
DATE
563318
820
820
820
820
820
820
000
000
000
000
000
000
000
000
000
000
000
000
DOCTOR
lorin^
TELEPHONE
E-FILED 2014 DEC 17 3:40
PM Hospital
COURT NO.
712-662-4008
GYANO, B. K.
MED. REC. NO. ) ADMISSION NO.
BILLING DATE
11/08/13
211 Highland Ave- Sac City, IA 50583
PAGE
BLUE CROSS 140

SELF-PAY
KHIAN4896757
111111111
PLAN
MED. REG. NO. / ADMISSION NO
S BARAIBARTHOMPSO
DUSTIN SANDERS
PATIENT
TYPE
225 S 11TH STREET

SAC CITY IA 50583
15
563318
SANDERS, DUSTIN
BARAIBAR-THOMPS
PATIENT NAME
GUARANTOR
34226 /
POLICY HOLDER
POLICY NUMBER
INSURANCE COMPANY
NO
EXTENSION
10/20/13
34226 /
BIRTHDATE
10/25/13
563318
SEX
AGE
11
DATE
CHARGE
CODE
DESCRIPTION
QUANTITY
CHARGE
SUMMARY OF CHARGES
INPUSION/CHEMO THERAPY
LABORATORY
PHARMACY
1224.00
62.00
2140.92
TOTAL CHARGES
3426.92
BALANCE
CPT
AMOUNT
3426.92
E-FILED 2014 DEC 17Loring

3:40 PMHospital
COURTNO.
TELEPHONE
DOCTOR
GYANO, B. K .
712-662-4008
BILLING DATE
10/31/13
PAGE
34226 /
21 1 Highland Ave Sac City, IA 50583
INSURANCE COMPANY
NO
POLICY NUMBER
KHIAN4896757
111111111
BLUE CROSS 140

SELF-PAY
GUARANTOR
SANDERS, DUSTIN
BARAIBAR-THOMPS
S BARAIBARTHOMPSO
PATIENT
TYPE
225 S 11TH STREET

SAC CITY IA 50583
13

34226 / 563301
10/18/13
BIRTHDATE
10/19/13
02
CHARGE
CODE
DESCRIPTION
10-18
QUANTITY
CHARGE
CPT
550.000
OBSERVATION ROOM
10 . 000
10.000
10.000
23 .410
23.410
107.930
107.930
AMOUNT
DEPT TOTAL
DEPT TOTAL
18 . 00
18. 00
18 .00
36.24
85 . 00
17.72
44 .00
44 . 00
57 .68
57 .68
91. 00
91. 00
38 .48
616.80
DEPT TOTAL
16.25
16.25
16.250
REFERRAL LABORATOR
PAY LAST
BALANCE
288 . 00
72 . 00
114.00
204.00
204.00
67 . 00
108 . 00
378.00
378 .00
1813 .00
18.000
18 . 000
18.000
36.240
85.000
17.720
44.000
44.000
57.680
57 . 680
91.000
91.000
38.480
LABORATORY
AGE
11
550.00
550.00
72 . 000
114 .000
204 .000
204 . 000
67 .000
54 .000
54 . 000
54 .000
INFUSION/CHEMO THE
SEX
DEPT TOTAL
72 . 000
10-18
563301
PLAN
POLICY HOLDER
PATIENT NAME
DUSTIN SANDERS
DATE
EXTENSION
10.00
10. 00
10.00
46 . 82
23.41
215.86
107.93
E-FILED 2014 DEC Lorintf

17 3:40 PM
COURT
Hospital
JLEPHONE
NO.
DOCTOR
GYAKO , B . K .
BILLING DATE
10/31/13

PAGE
INSURANCE COMPANY
POLICY NUMBER
KHIAN4896757
111111111
BLUE CROSS 140

SELF-PAY
34226 /
PATIENT
TYPE
225 S 11TH STREET

SAC CITY IA 50583
13
SANDERS, DUSTIN
BARAIBAR-THOMPS

34226 / 563301

10/18/13
BIRTHDATE
10/19/13
DESCRIPTION
QUANTITY
CHARGE
CPT
98.880
98.880
98. 880
106.250
267 . 020
340.820
340.820
2 .390
8.000
PHARMACY
RADIOLOGY, PROFESS
RADIOLOGY, TECH
IV SOLUTIONS
50 . 01
50 . 01
DEPT TOTAL
148.50
148 . 50
DEPT TOTAL
19.80
16 .34
17 .41
17 .41
70 . 96
125.000
125.000
97 . 000
97 . 000
10-18
10-19
10-18
10-19
RESPIRATORY THERAP
AMOUNT
DEPT TOTAL
19.800
16 .340
17.410
17 .410
10-18
10-18
10-18
10-19
PAY LAST
BALANCE
DEPT TOTAL
148 .500
10-18
AGE
98 . 88
98 . 88
98 .88
106.25
267.02
340.82
340.82
2 .39
8.00
1785 . 96
50.011
10-18
SEX
11
CHARGE
CODE
563301
PLAN
POLICY HOLDER
PATIENT NAME
S BARAIBARTHOMPSO
5UARANTOR
DUSTIN SANDERS
DATE
EXTENSION
712-662-4008
DEPT TOTAL
125.00
125. 00
97.00
194.00
541.00
DOCTOR
GYANO,
B.
Loiing
Hospital
E-FILED 2014 DEC 17
3:40 PM
COURT
TELEPHONE
NO.
K.
0-^,
BILLING DATE
^f\3
712-662-4008
PAGE
211
Highland
MED.
REC.Ave
NO. / ADMISSION NO.
Sac City, IA 50583
NO.
INSURANCE COMPANY
POLICY NUMBER
07 BLUE CROSS 140

05 SELF-PAY
KHIAN4 8 9 6 7 5 7
111111111
GUARANTOR
225
34226
POLICY HOLDER
PATIFNT
TYPE
SAC CITY IA
50583
13

34226 /

10/18/13
10/19/13
8IRTHDATE
f$^/Q2
DATE
CHARGE
CODE
DESCRIPTION
SUMMARY OF CHARGES
OBSERVATION ROOM
LABORATORY
REFERRAL LABORATORY
PHARMACY
RADIOLOGY, TECH
IV SOLUTIONS
RESPIRATORY THERAPY
CHARGE
QUANTITY
563301
SEX AGE
F
11
PAY LAST
BALANCE
AMOUNT
550.00
1813.00
616.80
16.25
1785.96
50.01
148 .50
70 .96
541.00
5592.48
TOTAL CHARGES
BALANCE
C*
563301
SANDERS, DUSTIN
BARAIBAR-THOMPS
S BARAIBARTHOMPSO
11TH STREET
PLAN
PATIENT NAME
DUSTIN SANDERS
EXTENSION
5592 . 4 8
Sl.Df
iftCLfcV
V V- i c\ \
\T
xi
/7J?
DOCTOR
Lorin#
Hospital
E-FILED 2014 DEC 17
3:40 PM
COURT
TELEPHONE
NO.
LANKFORD , TONYA
<V^
BILLING DATE
/\ \
10/17/13
NO.
PAGE
T;r
POLICY NUMBER
140
SELF-PAY

30756
POLICY HOLDER
SANDERS,
DUSTIN
VMA8926
SANDERS,
DUSTIN
PATIENT NAME
DUSTIN SANDERS
S
PATIFNT
SAC CITY IA
TYPE
50583
26
562814
DUSTIN SANDERS
11TH STREET
PLAN
KHIAN4896757
GUARANTOR
225
712-299-2998
211 Highland Ave Sac City, !A 50583
INSURANCE COMPANY
07 BLUE CROSS
05
EXTENSION
30756

10/09/13
10/09/13
BIRTHDATE
flK^^83
CHARGE
DATE
DESCRIPTION
QUANTITY
CHARGE
CPT
CODE
562814
SEX AGE
M
30
^^B^Tllmfl^^^l
AMOUNT
10-09
MV ^MMBMMfr
18. 0 0 0
18 . 0 0
10-09
i^VB
44 .000
44 . 00
91.000
10-09
w """*
91.00
LABORATORY
10-09
i^mm
10-09, ^Mv
DEPT TOTAL
<^MV*
RADIOLOGY,
PROFESS
^
B^
RADIOLOGY,
TECH
5 0 . Oil
DEPT TOTAL
148 . 5 0 0
153 . 00
y
s^-c\^^
148.50
DEPT TOTAL
148 .50
SUMMARY OF CHARGES
LABORATORY
153 .00
RADIOLOGY,
PROFESSIONAL
RADIOLOGY,
TECH
TOTAL CHARGES
3 .00
148. 50
3 0 4 . 50
BALANCE
\\-lrl3
tft
304 . 50
H.2,5
31.01
"QcjP&
\/
V
2ll>. 23
ft i2
C-'TT
'OL
^7/7
Loring
Hospital
TELEPHONE
E-FILED 2014 DEC 17
3:40 PM
COURTNO.
DOCTOR
GYANO, B. K.
'RK/^
BILLING DATE
12/06/13
O.
x^^Sv
PAGE
712-299-2998
INSURANCE COMPANY
POLICY NUMBER
BLUE CROSS 140

SELF-PAY
KHIAN4896757
UARANTOR
30756 /
POLICY HOLDER
SANDERS, DUSTIN
SANDERS, DUSTIN
DUSTIN SANDERS
PTYPENT
225 S 11TH STREET

SAC CITY IA 50583
20
30756 /
11/29/13
BIHTHDATE
11/29/13
CHARGE
CODE
DESCRIPTION
QUANTITY
CHARGE
OPT
REFERRAL LABORATOR
SUMMARY OF CHARGES
LABORATORY
REFERRAL LABORATORY
297 . 2 4
TOTAL CHARGES
358.70
BALANCE
AGE
30
PAY LAST
BALANCE
AMOUNT
DEPT TOTAL
DEPT TOTAL
30.73
30.73
61.46
30.730
30 .730
11-29
11-29
SEX
18.00
90 . 00
44 .00
91.00
54.24
297.24
18.000
90.000
44 .000
91. 000
54.240
LABORATORY
565112
DATE
565112
PLAN
PATIENT NAME
DUSTIN SANDERS
EXTENSION
61.46
358.70
1010.Ob
DOCTOR
GYANO,
B.
Lorin# Hospital
NO.
/\ X^
PAGE
BLUE CROSS
05
SELF-PAY
POLICY NUMBER
140

30837
POLICY HOLDER
KHIAN4896757
SANDERS, DUSTIN
SANDERS,
DMfe SANDERS
11TH STREET
PTYPENT
SAC CITY IA 50583
26
563957
DUSTIN
PATIENT NAME
DUSTIN SANDERS
PLAN
M08926
GUARANTOR
225
EXTENSION
518-227-0917
INSURANCE COMPANY
07
fof
<Vv
BILLING DATE
11/15/13
TELEPHONE NO.
K.
30837

11/01/13
BIRTHDATE
11/01/13
SEX AGE
W/06 M
CHARGE
CODE
agUjjUa
11-01
11-01
at***
11-01 &*^ff*
DESCRIPTION
UANTITY
CPT
CHARGE
11-01
oen*
j^M^
AMOUNT
1HBBMHMI9
18 . 0 0 0
18 . 00
MHVt
28.550
MH^Mfc
44 . 000
28.55
44 . 00
DEPT
LABORATORY
11-01
PAY LAST
BALANCE
DATE
563957
*
RADIOLOGY, PROFESS
50. 01
50. Oil
50.01
DEPT TOTAL
1
^M^
RADIOLOGY,
90 . 55
TOTAL
148.50
148.500
DEPT TOTAL
TECH
148.50
SUMMARY OF CHARGES
90.55
LABORATORY
RADIOLOGY,
PROFESSIONAL
RADIOLOGY,
TECH
50.01
148 .50
289.06
TOTAL CHARGES
2 8 9 . 06
BALANCE
nTT
4V75"
***
&
I
1
E-FILED 2015 JAN 02 1:05 PM SAC - CLERK OF DISTRICT COURT
IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY
Plaintiff(s),
LF NOLL, INC
705 DOUGLAS ST, STE 344
SIOUX CITY IA 51101

Case: 02811 SCSC015555
vs.
JUDGMENT ENTRY
Defendant(s),
ANGELA R SANDERS
225 S 11TH ST
SAC CITY IA 50583
DUSTIN J SANDERS
225 S 11TH ST
SAC CITY IA 50583-0
The court file shows that the defendants have received proper notice and have failed to answer. The
relief is readily ascertainable from the Original Notice. Pursuant to Iowa Code Section 631.5(6), the
defendant 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 $ 904.05 with interest at the rate of 2.21 % from the 17th day
of December, 2014 and court costs.
The Court further enters judgment for prejudgment interest in the amount of $25.84.
YOU ARE HEREBY NOTIFIED that you have a right to appeal the decision to the District Court by
giving written notice to the Small Claims Office within 20 days of the filing of this order. Filing Fee for
appeal is $185.00. Appeal Bond is set in the amount of: $1000.00
1 of 2
State of Iowa Courts

Case Number
SCSC015555
Type:
Case Title
L.F. NOLL, INC. V SANDERS, DUSTIN AND ANGELA
ORDER FOR JUDGMENT
So Ordered
Electronically signed on 2015-01-13 13:23:26
2 of 2

SCSC015555 - Judgment Against Sac City Couple in The Amount $904.05 PDF

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E-FILED 2014 DEC 17 3:40 PM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT FOR SAC COUNTY

E-FILED 2014 DEC 17 3:40 PM SAC - CLERK OF DISTRICT COURT

E-FILED 2014 DEC 17 3:40 PM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT FOR SAC COUNTY

TrlTNOLL, VICE PRESIDENT

E-FILED 2014 DEC 17 3:40 PM SAC -Account

PAY THIS AMOUNT

THIS ACCOUNT HAS BEEN LISTED WITH OUR AGENCY FOR

DE.AR DUS !'IN J SANDERS & ANGELA SANDERS,

THIS IS AN ATTEMPT TO COLLECT A DEBT,

s. I n - . '115 ] 1 ( ) [ CM .\ S 1 K I - I I. SI i l l .-44. S I O U X C I I ' Y IA <i I 1 1 ) 1 . P H ' ( 7 1 2) 2?2-t)^. I AX

IF PAVING BY CREDIT CARD. PLEASE FILL OUT BELOW

Personal & (.'imfldi'titiul

E-FILED 2014 DECNCS,

AS S 13 \''".-'; E N" T FOR PURPOSES OF SUIT

"or valuable oonsideratior., receipt hereby acknowledged, the undersigned here:

MED. REC. NO. / ADMISSION NO.

211 Highland Ave Sac City, IA 50583

225 S 11TH STREET

ADMISSION DATE DISCHARGE DATE

MED. REC. NO. / ADMISSION NO.

BLUE CROSS 140

211 Highland Ave Sac City, IA 50583

07 BLUE CROSS 140

225 S 11TH STREET

MED. REC. NO. / ADMISSION NO

ADMISSION DATE DISCHARGE DATE

E-FILED 2014 DEC 17

MED. REC. NO. / ADMISSION NO.

21 1 Highland Ave Sac City, IA 50583

BLUE CROSS 140

MED. REC. NO. / ADMISSION NO

225 S 11TH STREET

ADMISSION DATE DISCHARGE DATE

MED. REG. NO. / ADMISSION NO,

211 Highland Ave Sac City, IA 50583

MED. REC. NO, / ADMISSION NO

ADMISSION DATE DISCHARGE DATE

225 S 11TH STREET

MED. REC. NO. / ADMISSION NO.

27 T Highland Ave Sac City, IA 50563

MED. REC. NO. / ADMISSION NO.

ADMISSION DATE DISCHARGE DATE

BIRTHDATE j SEX AGE

ADMISSION DATE DISCHARGE DATE

MED. REC. NO. / ADMISSION NO.

MED. REC. NO. / ADMISSION NO.

211 Highland Ave Sac City, IA 50583

MED. REC. NO. / ADMISSION NO.

225 S 11TH STREET

MED. REC. NO. / ADMISSION NO.

ADMISSION DATE DISCHARGE DATE

E-FILED 2014 DEC 17Lorin#

21 1 Highland Ave Sac City, !A 50583

07 BLUE CROSS 140

MED. REC. NO. / ADMISSION NO.

ADMISSION DATE DISCHARGE DATE

REC. NO. / ADMISSION NO.

E-FILED 2014 DEC 17 3:40 PM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT FOR SAC COUNTY

For Defendant: DUSTIN J. SANDERS