You are on page 1of 7

E-FILED 2014 SEP 24 12:50 PM SAC - CLERK OF DISTRICT COURT

eForm 3.1: Original Notice and Petition for a Money Judgment

Sac
In the Iowa District Court for ________________
County
Plaintiff(s)
City of Wall Lake
________________________________________
(Name)

Original Notice and Petition


for a Money Judgment

108 Boyer St. Wall Lake, IA. 51466


________________________________________
(Address)

________________________________________
(Name)

________________________________________
(Address)

vs.
Defendant(s)
Kayla Bruns
________________________________________

(Name)

308 W Fifth St. Wall Lake, IA. 51466


________________________________________
(Address)

________________________________________
(Name)

________________________________________
(Address)

To Defendant(s):

2957.95
1. You are notified that Plaintiff(s) demand(s) from you the amount of $ ______________
plus court
costs based on (state briefly the basis for the demand, not to exceed $5000):
Non-payment of utility bill

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 clerks office of any address change.

Lynn Grosely
/s/ ________________________________

/s/ ________________________________

City of Wall Lake


___________________________________

___________________________________

Filing Plaintiff or Attorney

Law firm, or entity for which filing is made, if applicable

Second Plaintiff, if applicable

Law firm, or entity for which filing is made, if applicable

eForm 3.1, page 1 of 3

E-FILED 2014 SEP 24 12:50 PM SAC - CLERK OF DISTRICT COURT

P.O. Box 37 Wall Lake, IA. 51466


___________________________________

___________________________________

712.664.2216
___________________________________

___________________________________

citywl1@netins.net
___________________________________

___________________________________

___________________________________

___________________________________

Mailing address

Telephone number
Email address

Additional email address, if applicable

Mailing address

Telephone number
Email address

Additional email address, if applicable

eForm 3.1, page 2 of 3

E-FILED 2014 SEP 24 12:50 PM SAC - CLERK OF DISTRICT COURT

eForm 3.27: Verification of Account, Identification of Judgment Debtor, and Certificate Re Military
Service

Sac
In the Iowa District Court for ________________
County

Plaintiff(s)

City of Wall Lake


_______________________________________
(Name)

_______________________________________
(Name)

Defendant(s)

vs.

Verification of Account,
Identification of Judgment
Debtor, and Certificate
Re Military Service
Small Claim No. _____________________

Kalah Bruns
_______________________________________
(Name)

_______________________________________
(Name)

For Defendant: __________________________


(This form required for each Defendant.)

Lynn Grosely
1. I, ______________________________________________,
am a party or an employee of
Plaintiff(s) 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 creditors records
2957.95
showing the balance due is true and correct. I further state that the sum of $__________
is the
March 2014
balance due and owing as of ____________________________
from Defendant(s) to Plaintiff(s)
and any interest amount owing is accurately stated in the Petition or Original Notice.
unknown
2. I further state that Defendant resides at __________________________________________,
Twilight Acres Nursing Home Wall Lake, IA.
is employed at _________________________________________________________________,
unknown
and Defendants occupation is ____________________________________________________.
3. Check A, B, or C for Defendant:
A.
Defendant is not in the military service of the United States government, I have
verified this fact by (check one):
Checking the Defense Manpower Data Center (DMDC) (requires name and SSN
or name and date of birth) at https://www.dmdc.osd.mil/appj/scra/scraHome.do.
Contacting Defendant who informed me.
Regularly seeing Defendant and believing Defendant is not active in the U.S.
military.
OR
B.
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.
Defendant is in the military service of the United States government.
4. I also state to the best of my knowledge (check one):
Defendant
is
is not under a disability or confined in a 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.

09/23/2014
Date:__________________________________
712.664.2216
_______________________________________
Phone #
citywl1@netins.net
_______________________________________
EMail adress
_______________________________________
Additional email address, if appilcable

_______________________________________
Signature of Affiant
Lynn Grosely
/s/_____________________________________
Filing Plaintiff or Attorney
City of Wall Lake
_______________________________________
Law firm, or entity for which filing is made, if applicable

P.O. Box 37 Wall Lake, IA. 51466


_______________________________________
Mailing Address

E-FILED 2014 OCT 16 1:32 PM SAC - CLERK OF DISTRICT COURT

E-FILED 2014 OCT 28 9:30 AM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY

Plaintiff(s),
CITY OF WALL LAKE OTHER PIN
CITY OFFICES
PO BOX 37
WALL LAKE IA 51466

SMALL CLAIMS DIVISION


Case: 02811 SCSC015508

vs.
JUDGMENT ENTRY
Defendant(s),
KALAH BRUNS
308 W 5TH STREET
WALL LAKE IA 51466

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 $ 2957.95 with interest at the rate of 2.11 % from the 24th day of September,
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: $3,000.00

1 of 2

E-FILED 2014 OCT 28 9:30 AM SAC - CLERK OF DISTRICT COURT

State of Iowa Courts


Case Number
SCSC015508
Type:

Case Title
CITY OF WALL LAKE VS KAYLA BRUNS
ORDER FOR JUDGMENT
So Ordered

Electronically signed on 2014-10-28 09:30:14

2 of 2

You might also like