E-FILED 2014 FEB 03 8:51 AM SAC - CLERK OF DISTRICT COURT

UNITED STATES POSTAL SERVICE"

Date: February 24, 2014 Brent Miller: The following is in response to your February 21, 2014 request for delivery information on your Certified Mail item number 70101870000292550539. The delivery record shows that this item was delivered on February 24, 2014 at 11:24 am in LYTTON, IA 50561. There is no delivery signature on file for this item. Thank you for selecting the Postal Service for your mailing needs. If you require additional assistance, please contact your local Post Office or postal representative. Sincerely, United States Postal Service

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E-FILED 2014 FEB 26 1:17 PM SAC - CLERK OF DISTRICT COURT

E-FILED 2014 MAR 18 4:18 PM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT FOR SAC COUNTY IMT GROUP Petitioner, VS BRENT MILLER Respondent. 02811 SCSC015407

ORDER

Defendant is in default and his default is entered of record. However before judment can be entered it is necessary that a verification be filed. Plaintiff must file such verification at which point a judgment will be entered.

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E-FILED 2014 MAR 18 4:18 PM SAC - CLERK OF DISTRICT COURT

State of Iowa Courts Case Number SCSC015407 Type: Case Title IMT GROUP VS. BRENT MILLER OTHER ORDER So Ordered

Electronically signed on 2014-03-18 16:18:47

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E-FILED 2014 MAR 19 1:43 PM SAC - CLERK OF DISTRICT COURT

E-FILED 2014 MAR 19 1:43 PM SAC - CLERK OF DISTRICT COURT

Exhibit A Affiants knowledge regarding Defendants military status is based upon the following information, some of which is based on information from the client and other sources as cited: 1. On March 20, 2013 Adjuster Pete Pratkelis contacted the Defendants mother who advised she thought he was living in Mallard, IA. 2. On April 23, 2013 the Defendant spoke with Adjuster Pete Pratkelis by phone and advised that he can be reached by cell phone or through his mothers address. 3. On November 27, 2013 the Defendant met with adjuster Pete Pratkelis and executed a release. 4. On December 16, 2013 the Defendant spoke with Pete Pratkelis and Defendant agreed to meet with him at his home. No one answered the door when Mr. Pratkelis arrived. 5. On February 7, 2014 Diligent Service filed by Sac County Sheriff indicates that three attempts were made to serve the original notice and his mother indicates he is currently in Rockwell City or Fort Dodge. 6. On February 24, 2014 the Defendant signed for the Original Notice sent by Certified Mail. Based on the foregoing information, the affiant believes that the Defendant is not active in the U.S. military.

E-FILED 2014 MAR 19 1:43 PM SAC - CLERK OF DISTRICT COURT

Statement of Amount Owed Settlement reached on November 27, 2013, see attached release Amount of Check which was cashed on December 3, 2013 $ 750.00

$5,000.00

Overpayment owed to IMT Group

$4,250.00

E-FILED 2014 MAR 19 1:43 PM SAC - CLERK OF DISTRICT COURT

Claim No.: 2012Al171

RELEASE
The undersigned, Brent A Miller, Individually ("CIa' ant" and ing of I gal ) /"~ , --:acknowledges payment to me of the sum o f ' ($ 7S-0J!P ) in consideration of which payment I do hereby release, acquit a forever discharge Tony Heuton and Justin Heuton, Wadena Insurance Company and all other persons, ftrms and corporations ("Releasees"), from any and all liability whatsoever, including all claims, demands, and causes of action of every nature affecting me which I may have or ever claim to have by reason of: (a) Injuries sustained in an accident on 2/13/2012. As a further consideration of said payment I hereby agree:
1. That this Release agreement covers all injuries and damages, whether known or not and which may hereafter appear or develop arising from the matters above referred to.

2. That the above sum is all that I will receive for my claim and no promise for any other or further consideration has been made by anyone. 3. That this Release is executed as a compromise settlement of a disputed claim, liability for which is expressly denied by the party and/or parties released (Releasees), and the payment of the above sum does not constitute an admission of liability on the part of any person or entity. 4. That I am executing this release solely in reliance upon my knowledge, belief and judgment and not upon any representations made by the party released or others in their behalf. 5. That I have entered into this Release agreement of my own free will and that I have had the opportunity to consult with counsel of my own choice before entering into this agreement. 6. That I will negotiate and satisfy any and all medical bills and liens of medical providers, insurers, workers compensation carriers, local, state or federal governments or agencies thereof and all other persons or ftrms with liens or SUbrogation interests arising from this accident or from the proceeds of this settlement. The undersigned attorney guarantees the agreement herein to negotiate and pay all liens and subrogation interests in this case out of the proceeds of this settlement and to hold Releasees harmless from the same. 7. That I will defend, indemnify and hold harmless the Releasees herein from any and all liens, claims, demands, subrogation rights and causes of action whatsoever by anyone on account of the injuries and/or damages sustained in the aforementioned accident and/or with respect to the payment made pursuant to this release including any derivative claims such as those made by or on behalf of any spouse or minor child. 8. Undersigned, personally and through hislher legal representatives stipulates to the fact that as a condition of this settlement that the Releasee( s), their heirs, executors, administrators, agents, and assigns, and Wadena Insurance Company [hereinafter the Company] are materially relying upon my/our assertion that I1we have not applied and am/are not eligible to receive Medicare beneftts and/or Social Security disability beneftts as of the date of settlement. Undersigned agrees that I/we have not knowingly or unknowingly misrepresented my/our Medicare/Social Security disability beneftt status. Undersigned agrees to indemnify and/or hold harmless the Releasee(s), their heirs, executors, administrators, agents and

E-FILED 2014 MAR 19 1:43 PM SAC - CLERK OF DISTRICT COURT

assigns, and the Company, for any loss of Medicare benefits or for any recovery the Centers for Medicare and Medicaid Services may pursue including, but not limited to, those related to Social Security Disability. In addition, undersigned agrees personally and through hislher legal representatives to release as part of this agreement any right to bring any possible future action under 1395y ofthe Medicare Secondary Payer Statute (MSP) against the Releasees, their heirs, executors, administrators, agents and assigns and the Company. 9. This Release agreement constitutes the entire agreement among the parties to this agreement and supersedes all prior or contemporaneous agreements and understandings, oral or written, with respect to the subject matter herof. 10. With respect to the promises and covenants contained herein, I represent and warrant that I have not sold, assigned, transferred, conveyed or otherwise disposed of any claim, demand or action that is the subject ofthis Release agreement. THE TERMS OF THIS RELEASE AGREEMENT HAVE BEEN COMPLETELY READ AND ARE FULLY UNDERSTOOD AND ARE VOLUNTARILY ACCEPTED BY THE UNDERSIGNED FOR THE PURPOSE OF MAKING A FULL AND FINAL COMPROMISE, ADJUSTMENT, AND SETTLEMENT OF ANY AND ALL CLAIMS DISPUTED OR OTHERWISE, THAT CLAIMANT MADE OR COULD HAVE MADE AGAINST THE RELEASEES AS A RESULT OF THE INCIDENT AT ISSUE. Words and phrases herein shall be construed as in the singular or plural number, and as masculine, feminine or neuter gender, according to the context. Dated at Lytton Iowa this ----.<Z,----,,---day of AJ,}L}(<4h ,L ,2013.

CAUTION: THIS IS A RELEASE READ BEFORE SIGNING!

Witness

E-FILED 2014 MAR 19 1:43 PM SAC - CLERK OF DISTRICT COURT

E-FILED 2014 MAR 19 8:46 PM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY

Plaintiff(s), IMT GROUP 4445 CORPORATE DRIVE, ST 100 WEST DES MOINES IA 50266

SMALL CLAIMS DIVISION Case: 02811 SCSC015407

vs. JUDGMENT ENTRY Defendant(s), BRENT MILLER 415 CHESTNUT STREET LYTTON IA 50561

The court file shows that the defendant has received proper notice and has 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 defendant in the amount of $ 4,250.00 with interest at the rate of 2.12 % from the 3rd day of February, 2014 and court costs.

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: $5,000.00

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E-FILED 2014 MAR 19 8:46 PM SAC - CLERK OF DISTRICT COURT

State of Iowa Courts Case Number SCSC015407 Type: Case Title IMT GROUP VS. BRENT MILLER ORDER FOR JUDGMENT So Ordered

Electronically signed on 2014-03-19 20:47:07

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