E-FILED 2014 OCT 29 3:17 PM SAC - CLERK OF DISTRICT COURT

eForm 3.1: Original Notice and Petition for a Money Judgment

In the lowa District Court

for

Sac

Countv

Plaintiif(s)

Citv of Sac Citv

(Name)

Original Notice and Petition

for a Money Judgment

(Name)
(Address)

To Defendant(s):

1. You are notified that Plaintifi(s) demand(s) from you the amount of g 440.65
pius court
costs based on (state briefly the basis for the demand, not to exceed 95000):
Unpaid utility bills. Shawn & Lynsey were customers ofSac City and the City has tried to collect through previous
attempts.

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 lowa Judicial Branch Electronic
Document Management System (EDMS) at https://www. iowacourts.state.
from the court an exemption from electronic filing requirements.

ia.

us/EFile, unless you obtain

4. lf 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. lf you electronically file, EDNiIS 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).

Isl
Filing Plaintiff or Atlorney
City of Sac City
Law firm, or entity for which filing is made, if applicable

Second Plaintiff, if applicable

eForm 3.1, page

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

1 of 3

E-FILED 2014 OCT 29 3:17 PM SAC - CLERK OF DISTRICT COURT

302 E Main, PO Box 37, Sac Ciry, IA 50583

Mailing address

Mailing address

r?tr) 661-?{ol
Telephone number

Telephone number

saccitvst@prairieinel.net
Emailaddress

Emailaddrcss

saccityag@pmirieinet.net
Additional email address, if applicable

Additional email address, if applicable

eForm 3.1, page 2

of3

E-FILED 2014 NOV 04 10:02 AM SAC - CLERK OF DISTRICT COURT

eForm 3.27: verffication of Account, ldentification of Judgment Debtor, and cerlificate Re Mititarv
Seryice

In the lowa District Court

for

Sac

Plaintiff(s)

County

Verification of Account,
ldentification of Judgment
Debtor, and Certificate
Re Military Service

City of Sac Ci
(Name)

(Name)

Small Claim

Lynsey Johnson

No.

SCSC015532

For Defendant:

(Name)

(This form required for each Defundant.)

l. l,

Sandy Tellinghuisen
of
, am a party or an employee
'
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
is the
balance due and owing as of 8/12114
from Defendant(s) to Plaintiff(s)
and any interest amount owing is accurately stated in the Petition or Original Notice.

gj!!q!!_

2. I further state that Defendant resides at

605 Main Strcet, Duncombe,

IA

50532

is employed at

and Defendant's occupation is

3.

Check A. B. or C for Defendant:

A. O Defendant is not in the military service of the United States government, I have
verified this fact by (check one):

EChecking the Defense Manpower Data Center (DMDC) (requires name and SSN

or name and date of birth) at https://www.dmdc.osd.mil/appi/scra/scraHome.do.

EContacting Defendant who informed me.
ERegularly 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

the military service of the United States government.
OR C. O Defendant is in the military serviCe of the United Stares governmenr.
4.

is in

I also state to the best of my knowledge (check one):

Defendant
penitentiary.

Qis

Qis not

under a disability or confined in a reformatory, jail, or

I certify under penalty of perjury and pursuant to the laws of the state of lowa that these facts are
true and correct.

Dalr..8tr2^4
(112) 662-'/ 593
Phone #

saccityst@plairieinet.net

Filing Plaintiff or A

City of Sac City

Law firm, or entity for which filing is made, if appli-cable

saccityag@prairieinet.net
Addrtronal email address. if aDoilcable

102 E Main. PO Box 17. Sac Cirv.

Marlrno Address

lA

50581

SERVICE ADDBESS

E-FILED 2014 NOV 04 10:02 AM SAC - CLERK OF DISTRICT COURT

ryPE OF SERVICE

GB RESIDENT
MC RES]DENTIA],
RG RESIDENT]AI.,
WA RESIDENT]AL
SW RESIDENTIAL

METER READING

READING DATES
FROITit

TO

PRESENT

4/01-/14 I a/2s/ta

4/0t/74
4/0t/14
4/07/t4

4/0r/t4

TAX
TOTA].,, CURRENT MONTH

15.00
.00

4/25/1,4

a/)c/14
a/)E,/14

PREVrous

I
386857
110593
I-LUf,YJ

378396
L0 9 482
L0 9 482

I47'L
1111
1- 1- 11

79.63
16-23

24.72
1.94

53 .*W4

E-FILED 2014 NOV 04 10:02 AM SAC - CLERK OF DISTRICT COURT

.,dYER & ,JOHNSON

, PARK AVE

,c crTY

rCCT

NO:

0000242507

OF SERV]CE

TA

50583

PREV BII-.,L 3/L4

PAYMENT 4/08

tr, / n1
T,ATtr a'I.I.]
BALANCE FORWARD

BEADING DATES

FRON4 I

GB RES IDENTIAL
RG RESIDENTIA],
WA RESIDENT]AL
SW RESIDENTIAL

TO

PRESENT

4/Ot/14
4/0r/14
4/0L/L4

PBEVrous

362809
107956
to7956

37 8396
L0 9 482

L09482

+4ffi1 fl L^

USAGE
(CF/GAL)

TAX

TOTAL CURRENT

5.85

METER READING

4/0r/L4

3/03/L4
3/03/14
3/03/14
3/03/14

396.46

15587
L526

15.00
r83.26
19.05

]_526

28 .17

s' z4a=4

MONTH
"l,

'Ll

l8+

SERVICE ADDRESS

STATEMENT

NIEMEYER & .JOHNSON

520 PARK AVE

NO:

0000242507

TYPE OF SERV]CE

GB RESIDENTI
RG RESIDENTIAL
WA RES IDENTIAL
SW RESIDENTIAL
TAX

TOTAL CURRENT

IA

50583

FROM
2/03/a4
2/03/a4
2/03/L4
2/03/L4

PAYMENT 2/20

BALANCE FORWARD

BEADING DATES

MONTH

BILL 2/13
LATE CHc 4/07
PREV

sAc crTY

ACCT

rs-

METEF READING
TO

3/03/!4

3/03/14

3/03/1,4

3/03/t4

PRESENT

352809
I07 956
L0'7 956

PREVrous

3344L3
10 5 915
105915

All

11

424

JI.A-

!8

8.16

-.*&r.4Ll-^
ffi

USAGE

(cF/GAL)

28396

204I
204]-

L5--041'.!-

3zffitJfL
Z2<#L
+ffi3 Jl.4Le
ffi+ (L
39,#6

aq 62,

12/04/2014 10:14:53

WEBSTER COUNTY SHERIFF

Page #

E-FILED 2015 JAN 02 2:01 PM SAC - CLERK OF DISTRICT COURT

*** RETURN OF SERVICE ***

IN THE IOWA DISTRICT COURT FOR

CASE NAME:

SAC COUNTY

SUBSTITUTE

CITY OF SAC CITY

VS

NIEMEYER,SHAWN
JOHNSON,LYNSEY
CASE NO:

SCSC015532

NOTICE RECEIVED:
STATE OF:

12/01/2014

IOWA

WEBSTER
COUNTY
I certify that I served a copy of:
ORIG NOT/PETITION
Petition and Original Notice
Modification/Application and Notice
Order to Show Cause

Served NIEMEYER,SHAWN

Order Filed_________________________________
Writ________________________________________
Other_______________________________________

by Serving JOHNSON,LYNSEY ROOMMATE

at 2133 180TH STREET
FORT DODGE, IA 50501
on 12/03/2014 at 11:00

NOTE:(Diligent Search, etc.)

Service :
Mileage :
Trust/Copy :
MISC. :

25.50
18.24
0.00
0.00

TOTAL :

43.74

JAMES V STUBBS, SHERIFF

WEBSTER
County, IOWA

MINDY ANDERSON SP DEPUTY

Signature
Fees charged to/paidby Atty/Party: CITY OF SAC CITY

Title

12/04/2014 10:16:33

WEBSTER COUNTY SHERIFF

Page #

E-FILED 2015 JAN 02 2:01 PM SAC - CLERK OF DISTRICT COURT

*** RETURN OF SERVICE ***

IN THE IOWA DISTRICT COURT FOR

CASE NAME:

SAC COUNTY

PERSONAL

CITY OF SAC CITY

VS

NIEMEYER,SHAWN
JOHNSON,LYNSEY
CASE NO:

SCSC015532

NOTICE RECEIVED:
STATE OF

12/01/2014

IOWA

WEBSTER
COUNTY
I certify that I served a copy of: ORIG NOT/PETITION
Petition and Original Notice
Modification/Application and Notice
Order to Show Cause

Served JOHNSON,LYNSEY

Service :
Mileage :
Trust/Copy :
MISC. :

0.00
0.00
0.00
0.00

TOTAL :

0.00

Order Filed_________________________________
Writ________________________________________
Other_______________________________________

at 2133 180TH STREET

FORT DODGE, IA 50501

on 12/03/2014 11:00

JAMES V STUBBS, SHERIFF

WEBSTER
County, IOWA

MINDY ANDERSON SP DEPUTY

Signature
Fees charged to/paidby Atty/Party: CITY OF SAC CITY

Title

E-FILED 2015 JAN 03 9:12 PM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY

Plaintiff(s),
CITY OF SAC CITY - OTHER PIN
PO BOX 37
SAC CITY IA 50583

SMALL CLAIMS DIVISION

Case: 02811 SCSC015532

vs.
JUDGMENT ENTRY
Defendant(s),
LYNSEY JOHNSON
2133 180TH STREET
FORT DODGE IA 50501
SHAWN NIEMEYER
2133 180TH STREET
FORT DODGE IA 50501

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 $ 440.65 with interest at the rate of 2.13 % from the 29th day
of October, 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: $500.00

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E-FILED 2015 JAN 03 9:12 PM SAC - CLERK OF DISTRICT COURT

State of Iowa Courts

Case Number
SCSC015532
Type:

Case Title
SAC CITY VS. SHAWN NIEMEYER & LYNSEY JOHNSON
ORDER FOR JUDGMENT
So Ordered

Electronically signed on 2015-01-03 21:12:15

2 of 2