E-FILED 2014 SEP 08 1:51 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)

Farmers State Bank

(Name)

Original Notice and Petition

for a Money Judgment

401 Main Street. Lake View. IA

(Address)
(Name)
(Address)

vs.
Defendant( s)

Lane Pugh
(Name)

3274 365th Street, Auburn, IA 51433

(Address)
(Name)
(Address)

To Defendant(s):
1. You are notified that Plaintiff(s) demand(s) from you the amount of $ ....;4..<.;,0;.;;.3_1;.;...9..;;..0
plus court
costs based on (state briefly the basis for the demand, not to exceed $5000):
Unpaid promissory note of $4,031.90

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:llwww.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.
15/

Joni Heun

Filing Plaintiff or Attomey

/5/

Second Plaintiff, if applicable

Farmers State Bank

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

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

eForm 3.1, page 1 of 3

E-FILED 2014 SEP 08 1:51 PM SAC - CLERK OF DISTRICT COURT

401 M3:in Street,

Lake ViEW", IA 514::1)

Mailing address

Mailing address

112-657~8525
TeleRhoR~ number

Telephone number

Email address

Email address

Additional em ail address, if applicable

Additional email address, if applicable

fsbh.llaia..atelECaIl. ret

eForm 3.1, page 2 of 3

E-FILED 2014 SEP 08 1:51 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

Plaintiff( s)

County
Verification of Account,
Identification of Judgment
Debtor, and Certificate
Re Military Service

Fanners State Bank

(Name)

(Name)

Small Claim No.

vs.

Defendant( s)

Lane Pugh
(Name)

For Defendant:
(Name)

~-:-

__

~~_---:--=--;--~-:-:

(This form required

for each Defendant)

1. I, Joni Heun, Cashier

, 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 creditor's records
showing the balance due is true and correct. I further state that the sum of $ 4,031.90
is the
balance due and owing as of 9-8-14
from Defendant(s) to Plaintiff(s)
and any interest amount owing is accurately stated in the Petition or Original Notice.
2. I further state that Defendant resides at 3274 365th Street, Auburn, IA 51433
is employed at :-"u;;::nkn=o;;.,;.Wll.:..:::...-:-:----:-_-:and Defendant's occupation is ...::U;;::nkn=O;;.,;.Wll.:..:::...

_
_

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):
0Checking 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.

OR
OR

DContacting Defendant who informed me.

DRegularly seeing Defendant and believing Defendant is not active in the U.S.
military.
B. 0 I have investigated, and I am unable to determine whether or not Defendant is in
the military service of the United States government.
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 Ois 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.
Date: 9-8-14

~iLb1/J
Si

ature of Affiant

712-657-8525

Isl Joni Heun, Cashier

Phone#
fsblv@iowatelecom.net
EMail adress

Filing Plaintiff or Attomey

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

Additional email address, if appilcable

401 Main Street, Lake View, IA 51450

Mailing Address

E-FILED 2014 SEP 16 12:28 PM SAC - CLERK OF DISTRICT COURT

E-FILED 2014 OCT 06 9:32 AM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY

Plaintiff(s),
FARMERS STATE BANK
PO BOX 428
401 MAIN STREET
LAKE VIEW IA 51450

SMALL CLAIMS DIVISION

Case: 02811 SCSC015501

vs.
JUDGMENT ENTRY
Defendant(s),
LANE MATTHEW PUGH
3274 365TH STREET
AUBURN IA 51433-7567

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 $ 4031.90 with interest at the rate of 2.11 % from the 8th 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: $4,100.00

1 of 2

E-FILED 2014 OCT 06 9:32 AM SAC - CLERK OF DISTRICT COURT

State of Iowa Courts

Case Number
SCSC015501
Type:

Case Title
FARMERS STATE BANK VS LANE PUGH
ORDER FOR JUDGMENT
So Ordered

Electronically signed on 2014-10-06 09:31:51

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