E-FILED 2015 FEB 05 10:46 AM 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

RODNEY K. TEGLAND
PO BOX 401
304 WILLOW ST
ODEBOLTIA 51458

NO.

BRANDI TEGLAND
PO BOX 401
304WILLOWST
ODEBOLTIA 51458
DEFENDANT(S)
To Defendant(s):
1. You are notified that the above-named Plaintiff demands of you the amount of $1236.97. 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
PATERA FAMILY DENTISTRY

PRINCIPAL
$1236.97

PRE-FILING INTEREST
$0.00

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
a torney(s) for Plaintiffs). 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.

E-FILED 2015 FEB 05 10:46 AM SAC - CLERK OF DISTRICT COURT

Qc^a

(JESSICA R. NOLL AT0008873

705 Douglas St., Ste 502
Sioux City IA 51101
Phone (712) 224-2675
Fax (712) 252-4497
jrn@decklaw.net
ATTORNEY FOR PLAINTIFF

0002843170
FEBRUARYS, 2015

E-FILED 2015 FEB 05 10:46 AM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT FOR SAC COUNTY

SMALL CLAIMS DIVISION
L. F. NOLL, INC.
PLAINTIFF

VERIFICATION OF ACCOUNT
IDENTIFICATION OF JUDGMENT
DEBTOR AND CERTIFICATE RE
MILITARY SERVICE

VS
NO.
RODNEY K. TEGLAND
BRANDITEGLAND
DEFENDANT(S)

For Defendant: BRANDI TEGLAND

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 $1236.97 is the balance due and owing as of FEBRUARY 3, 2015 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, BRANDI TEGLAND, resides at PO BOX 401 304 WILLOW ST ODEBOLT IA
51458, 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.

T.-T NOLL, VICE PRESIDENT

705 Douglas St., Suite 344
Sioux City, IA51101
712-252-0583
0002843170

PATF-RA FAMILY DENTISFRY

E-FILED 2015 FEB 05 10:46 AM SAC - CLERK0002972688

OF DISTRICT COURT
S123h.97
SI236 97

\'CS. Im;.
ilha Noll Collection Service
"A Professional Debt Cullcclion Service Since 1965"

October 10,2014

f
I^_.

THIS ACCOUNT HAS BEEN LISTED WITH OUR AGENCY FOR

COLLECTION.
--.?.-?.<-.
--^

]
J
^

DEAR BRANDI TEGLAND & RODNEY K TEGLAND.

YOU ARE IN DEFAULT ON THIS CREDIT TRANSACTION. YOU H A V E A R I G H T TO CORRECT THIS
DEFAULT. IF YOU DO SO, YOU MAY CONTINUE WITH THE CONTRACT AS THOUGH YOU DID
NOT DEFAULT.
YOUR DEFAULT CONSISTS OF: F A I L U R E TO PAY AS AGREED
CORRECT THIS DEFAULT BY: PAYING THE AMOUNT EN DEFAULT, S1236.97 TO NOLI,
COLLECTION SERVICE, AGENT FOR T i l l - ABOVE CREDITOR.
IF YOU DO NOT CORRECT THIS DEFAULT WITHIN 30 DAYS. WE MAY EXERCISE OUR RIGI ITS
AGAINST YOU UNDER THE LAW.
IF YOU DEFAULT AGAIN WITHIN THE N E X T Y E A R , WE MAY EXERCISE OUR RIGHTS WITHOUT
SENDING, YOU ANOTHER NOTICE LIKE THIS ONE. IF YOU H A V E A N Y QUESTIONS. W R I T E OR
TELEPHONE PROMPTLY.
UNLESS YOU DISPUTE THE VALIDITY OF THE DEBT OR ANY PORTION THEREOF. WITHIN 30
DAYS AFTER RECEIPT OF THIS NOTICE. WE SHALL ASSUME THE DEBT TO BE VALID. IF YOU
NOTIFY US IN WRITING OF YOUR DISPUTE WITHIN THIS 30 DAY PERIOD. WE WILL OBTAIN
VERIFICATION OF Tl IE DEBT AND WILL MAIL YOU A COPY. UPON YOUR WRITTEN REQUEST
WITHIN A THIRTY DAY PERIOD WE WILL PROVIDE YOU WITH THE N A M E AND AN ADDRESS
OF THE O R I G I N A L CREDITOR IF DIFFERENT FROM THF: CURRENT CREDITOR.
SINCERELY,
NOLL COLLECTION SERVICE
We offer convenient Payment Options

Mail payment in
enclosed envelope

Pay online:
www.ncscollects.com

Call us:
(712)252-0583

THIS IS AN ATTEMPT TO COLLECT A DEBT,

ANY INFORMATION OBTAINED W I L L BE USED F O R T F I A T PURPOSE.
\CS, Im- . 705 DO! fil A S S 1 K L I I. Sl.l I I U4. SIOl.'X C ' l t V 1A M 101. PH: ( 7 1 2 ) 2S2-05IO. I ' A X i ( 7 1 Jj-213-3404. Lm:nl mail a MCSCO|!L:I-N

PC) BOX W

s i o i ; x r n V I A 51102-0593
Personal & Confidential

NCS INC
P O B O X 593
URANDITEGLANI)
RODNEY K T L G L A N D
304 WILLOW ST
K> BOX 401
ODLBOLT. IA 5145S-040I

SIOUX CITY IA 51102-0593

E-FILED 2015 FEB 05 10:46 AM SAC - CLERK OF DISTRICT COURT

NCS, INC DBA
NOLL COLLECTION SERVICE
"A Professional Debt Collection Service Since 1965"
705 DOUGLAS STREET, SUITE 344
SIOUX CITY, IA 51101
(712) 252-0583
DATE: JANUARY 26, 2015
PATERA FAMILY DENTISTRY

023787

700 E 2ND ST
IDA GROVE, IA 51445
ATTENTION:
RE: BRANDI TEGLAND
$1236.97
10/08/14
The above debtor refuses to cooperate. We recommend further action, in
order to enforce collection. Before our attorney can proceed, we will require:
* Completion of the assignment at the bottom of this page.
* Copy of the itemized statement showing balance due (if not
previously provided)
* If the original account is a contract or note, we must have the
original .
Please return promptly. Court costs will be advanced on your behalf.
Do not accept payments or make arrangements, without calling us first.
THANK YOU FOR YOUR COOPERATION

ASSIGNMENT FOR PURPOSES OF SUIT

For valuable consideration, receipt hereby acknowledged, the undersigned hereby
assign, transfer, and set over unto L.F. Noll, Inc. that certain claim against
BRANDI TEGLAND
RODNEY K TEGLAND
for goods, wares and merchandise sold and delivered or services rendered and
performed in the principal amount of $1236.97 plus lawful interest
thereon; and does hereby authorize said assignee to do and perform all acts
necessary for collection; commencement of suit in the name of the assignee,
settlement, adjustment, compromise or satisfaction of said claim. Assignor
hereby certifies that said claim is justly due and owing and warrants
compliance with requirements of the Iowa Consumer Credit Code as well as
disclosure and other provisions of t-Kuth in lending, and that same is free of
set-offs and other defenses

THIS IS AN ATTEMPT TO COLLECT A DEBT,

ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
0002972688

E-FILED 2015 FEB 05 10:46 AM SAC - CLERK OF DISTRICT COURT

STATEMENT

Patera Family Dentistry

700 East 2nd Street Ste. #1
Ida Grove, IA 51445-9998
(712)364-3101

01/29/2015
Account Number 7608
Amount Due
0.00

Date Due
Upon Receipt

Amount Enclosed

CREDIT CARD TYPE.

3 DIGIT CSV.

Rodney K Tegland
304 Willow St
PO Box 401
Odebolt,IA51458

EXPIRES
AMOUNT APPROVED.
NAME.
SIGNATURE.
PLEASE DETACH AND RETUJIN THE UPPER 1'OflTION WITH YOUR PAYMENT

0-30 0.00

61-90
0.00

31-60
0.00

over 90

0.00

Total:
-Ins Estimate:
=Balance:

$0.00
$0.00
$0.00

Rodney K Tegland
:.- -=: Patient

Code

08/31/2006

Rodney 'Rod'

4 tm*

08/31/2006

Rodney 'Rod'

09/05/2006

Rodney 'Rod'

11/30/2006

Date

12/28/2006
01/10/2007

Tooth

-} .-:;:-. - ' : i ^Description

Balance Forward
MMM^

warn
tmm 18

Rodney 'Rod'
Rodney 'Rod'

lAdjust

Rodney 'Rod'

Charges

Credits

27.00

Balance
33.40
60,40
77.40

17.00
665,00

742.40

Dentrix Adjustment

9.98

752.38

Adjust

Oentrix Adjustment

9.98

Adjust

Dentrix Insurance Pay

532.00

230.36

35.20

195.16

762.36

01/10/2007

Rodney 'Rod1

Adjust

Dentrix Insurance Pay

02/01/2007

Rodney 'Rod'

Adjust

Dentrix Adjustment

1.62

196.78

03/01/2007
03/29/2007

Rodney 'Rod'
Rodney 'Rod1

Adjust
Adjust

Dentrix Adjustment
Oentrix Adjustment

1.77

1.77

198.55
200.32

05/01/2007
05/31/2007

Rodney 'Rod'
Rodney 'Rod'

Adjust
Adjust

Dentrix Adjustment

1.82

202.14

Dentrix Adjustment

1.85

06/28/2007

Rodney 'Rod'

Adjust

Dentrix Adjustment

1.85

203.99
205.84

07/31/2007
08/30/2007
10/09/2007

Rodney 'Rod'
Rodney 'Rod'

Adjust

Dentrix Adjustment
Dentrix Adjustment

1.90

207.74

1.93

209.67

Adjust
Slmt

Rodney 'Rod'

11/19/2007

Rodney 'Rod'

Pay

03/12/2012
03/12/2012

Rodney 'Rod'
Rodney 'Rod'

MB
M

03/12/2012

Rodney 'Rod'

mum

03/12/2012

Rodney 'Rod'

Claim

03/12/2012

Rodney 'Rod'

Pay

03/20/2012
03/29/2012
04/02/2012
04/02/2012
04/02/2012

AM

Rodney 'Rod1
Rodney 'Rod'
Rodney 'Rod'
Rodney 'Rod'
Rodney 'Rod1

Stmt

Statement-Mail
Cash $132.67

M*

i
18

pBHbp

fl8

(^^^l
Statement-Electronic
^^^^^^^__^^^^^^^^^^^

77.00
135.00
159.00
159.00

0.00

Pri Claim $82.00 Gomaco Godbersen Smith

Received 04/10/2012
Payment: $65.60
Cash $10,00

mm
A

132.67
58.00
24.00

10.00
0.00

149.00
149.00

64.00
109.00

213.00
322.00

31.00

353.00

E-FILED 2015 FEB 05 10:46 AM SACDescription

- CLERK OF DISTRICT COURT

Date
04/02/2012

Patient
Rodney 'Rod1

j Code

04/02/2012

Rodney 'Rod'

MPW

04/02/2012

Rodney 'Rod'

Claim

04/02/2012

Rodney 'Rod'

Pay

Pri Claim $1,168.00 Gomaco Godbersen Smith

Received 05/07/2012
Payment: $934.40
Cash $70.00

04/02/2012

Rodney 'Rod1

rStmt

Statement-! nPerson

04/10/2012

Rodney 'Rod'

04/17/2012

Rodney 'Rod'
Rodney 'Rod'

InsPay
/din

Insurance Payment for Claim 03/12/2012

Clinical Note (NoBilllns)

04/17/2012

fbbth

^^^^__^^^^^_*
18

ft
*
*
>MH^r

Rodney 'Rod'

V*
2
*

Rodney 'Rod'

04/17/2012

"Rodney 'Rod'

Claim

05/01/2012

Rodney 'Rod'

05/07/2012

Rodney 'Rod'

Stmt
InsPay

05/31/2012

Rodney 'Rod'

Stmt

Credits

799.00

'

04/17/2012
04/17/2012

Charges^
165.00

/Balance
518.00
\\7.0Q

70.00

1,247.00

65,60

1,181.40

0.00

136.00

1,181.40
1,271.40
1,407.40

625.00

2,032.40

90.00

Prt Claim $851.00 Gomaco Godbersen Smith

Received 05/07/2012
NO PAYMENT
Statement- Electronic
Insurance Payment for Claim 04/02/2012

934.40

1,098.00

Statement-Electronic
Statement-Electronic

07/03/2012

Rodney 'Rod1

07/03/2012

Rodney 'Rod'

Stmt
Adjust

07/30/2012
07/30/2012

Rodney 'Rod'

Stmt

Statement-Electronic

Rodney 'Rod'

Adjust

Finance Charge

08/30/2012

Rodney 'Rod'

Stmt

Statement-Electronic

08/30/2012

Rodney 'Rod'

Adjust

10/01/2012
10/01/2012

Rodney 'Rod'

Adjust

Rodney 'Rod'

Stmt

Statement-Electronic

10/31/2012
11/01/2012

Rodney 'Rod'

Adjust
Stmt
Adjust

Finance Charge

3.71

1,101.71

16.47

1,118.18

Finance Charge

16.47

Finance Charge

16.47

1,134.65
1,151.12

Finance Charge
Statement-Electronic

16,77

1,167.89

Finance Charge
Statement-Electronic

16.77

1,184.66

Stmt

Rodney 'Rod'

Stmt
Adjust

Statement-Electronic
Finance Charge

17.02

1,201.68

01/31/2013

Rodney 'Rod'

Stmt

Statement-Electronic

01/31/2013

Adjust
Stmt

17.52

1,219.20

02/28/2013

Rodney 'Rod'
Rodney 'Rod'

02/28/2013
02/28/2013

Rodney 'Rod'
Rodney 'Rod'

Adjust
Adjust

11/27/2012
11/27/2012
12/27/2012
12/27/2012

Rodney 'Rod1
Rodney 'Rod'
Rodney 'Rod'
Rodney 'Rod'

_ _ _
' "

Finance Charge
Statement-lnPerson
Bad Debt Write-Off
Finance Charge

1,236.97
17.77

-17.77

0.00

E-FILED 2015 FEB 05 10:46 AM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT FOR SAC COUNTY

SMALL CLAIMS DIVISION
VERIFICATION OF ACCOUNT
IDENTIFICATION OF JUDGMENT
L. F. NOLL, INC.
DEBTOR AND CERTIFICATE RE
PLAINTIFF
MILITARY SERVICE
VS
NO.
RODNEY K.TEGLAND
For Defendant: RODNEY K. TEGLAND
BRANDI TEGLAND
DEFENDANT(S)

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 $1236.97 is the balance due and owing as of FEBRUARY 3, 2015 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, RODNEY K. TEGLAND. resides at PO BOX 401 304 WILLOW ST ODEBQLT
IA 51458. is employed at GOMACO CORPORATION 121 E. STATE HIGHWAY 175 PO BOX 151 IDA
GROVE IA 51445. 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.
n Contacting Defendant who informed me, or
[ i 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, IN

T. JxfiOLL, VICE PRESENT

705 Douglas St., Suite 344
Sioux City, IA 51101
712-252-0583
0002843170

PATERA !- AMILY DEN'HSTRY

E-FILED 2015 FEB 05 10:46 AM SAC - CLERK0002Q7268K

OF DISTRICT COURT
1 236.97

NCS. Inc

tiha Noll Collection Sen ice

"A Professional Debt Collection Service Since 1965"

October 10,2014

THIS ACCOUNT HAS BEEN LISTED WITH OUR AGENCY FOR

COLLECTION.
DEAR BRAND1 TEGLAND & RODNEY K TEGLAND.
YOU ARE IN D E F A U L T ON THIS CREDIT TRANSACTION. YOU H A V E A RIGHT TO CORRECT THIS
DEFAULT IF YOU DO SO, YOU MAY C O N T I N U E W I T H Till-: CONTRACT AS THOUGH YOU DID
NOT DEFAULT.
YOUR DEFAULT CONSISTS OF: F A I L U R E TO PAY AS A G R E E D
CORRECT THIS DEFAULT BY: PAYING THE AMOUNT IN DEFAULT, SI 236.97 TO NOLL
COLLECTION SERVICE, AGENT FOR THE ABOVE CREDITOR.
IF YOU DO NOT CORRECT THIS DEFAULT W I T H I N 30 DAYS. WE MAY EXERCISE OUR R I G H T S
A G A I N S T YOU UNDER THE LAW.
IF YOU D E F A U L T AGAIN W I T H I N THE Nl XT Y E A R , WE MAY EXERCISE OUR RIGHTS W I T H O U T
S E N D I N C i YOU ANOTHER NOTICE L I K E THIS ONE. IF YOU H A V E ANY QUESTIONS. W R I T E OR
TELEPHONE PROMPTLY.
UNLESS YOU DISPUTE THE VALIDITY OF THE DEBT OR ANY PORTION THEREOF. WITHIN 30
DAYS AFTER RECEIPT OF THIS NOTICE. WE SHALL ASSUME THE DEBT TO BE VALID. IF YOU
NOTIFY US IN WRITING OF YOUR DISPUTE WITHIN THIS 30 DAY PERIOD. WE WILL OBTAIN
VERIFICATION OF THE DEBT AND WILL M A I L YOU A COPY. UPON YOUR WRITTEN REQUEST
W I T H I N A T H I R T Y DAY PERIOD WE W I L L PROVIDE YOU WITH THE N A M E AND AN ADDRESS
OF THE O R I G I N A L CREDITOR IF DIFFERENT FROM THE C U R R E N T CREDITOR.
SINCERELY,
NOLL COLLECTION SERVICE
We offer convenient Payment Options

.S
Mail payment in
enclosed envelope

Pay online:
www.ncscollects.com

Call us:
(712)252-0583

THIS IS AN ATTEMPT TO COLLECT A DEBT,

ANY INFORMATION OBTAINED W I L L BE USED FOR THAT PI RPOSE.
VS.

Inc., 705 DC) I (,l AS SI Klil: I. SUM I- 'J4. S I O l ' X C I T Y !A 5 1 1 0 1 . P H : |712| 252-05K3. t f\\- (712)-213-3404. Kmail mail

PO FiOX

S I O l i X C I I Y IA 5 It 02-0593
Personal & Confidential

HRAN'DI ThGLAND
RODNEY K T E G L A N D
304 WILLOW S'[
PO BOX 401
ODFBOLT. IA 5145X-0401

NCS INC
PO BOX 593
S I O L ' X C I T Y IA SI 102-0593

E-FILED 2015 FEB 05 10:46 AM SAC - CLERK OF DISTRICT COURT

NCS, INC DBA
NOLL COLLECTION SERVICE
"A Professional Debt Collection Service Since 1965"
705 DOUGLAS STREET, SUITE 344
SIOUX CITY, IA 51101
(712) 252-0583

DATE: JANUARY 26, 2015

PATERA FAMILY DENTISTRY

023787

700 E 2ND ST
IDA GROVE, IA 51445

ATTENTION:
RE: BRANDI TEGLAND
$1236.97
10/08/14
The above debtor refuses to cooperate. We recommend further action, in
order to enforce collection. Before our attorney can proceed, we will require:
* Completion of the assignment at the bottom of this page.
* Copy of the itemized statement showing balance due (if not
previously provided)
* If the original account is a contract or note, we must have the
original.
Please return promptly. Court costs will be advanced on your behalf.
Do not accept payments or make arrangements, without calling us first.
THANK YOU FOR YOUR COOPERATION
ASSIGNMENT FOR PURPOSES OF SUIT
For valuable consideration, receipt hereby acknowledged, the undersigned hereby
assign, transfer, and set over unto L.F. Noll, Inc. that certain claim against
BRANDI TEGLAND
RODNEY K TEGLAND
for goods, wares and merchandise sold and delivered or services rendered and
performed in the principal amount of $1236.97 plus lawful interest
thereon; and does hereby authorize said assignee to do and perform all acts
necessary for collection; commencement of suit in the name of the assignee,
settlement, adjustment, compromise or satisfaction of said claim. Assignor
hereby certifies that said claim is justly due and owing and warrants
compliance with requirements of the Iowa Consumer Credit Code as well as
disclosure and other provisions of t-Kjuth in lending, and that same is free of
set-offs and other defenses
Dated this
PATERA FAMILY DENTISTRY
By:

(Name\arfd\Of f icVLe
j ^--..J
\s
THIS IS AH ATTEMPT TO COLLECT A DEBT,
ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
0002972688

E-FILED 2015 FEB 05 10:46 AM SAC - CLERK OF DISTRICT COURT

STATEMENT

Patera Family Dentistry

700 East 2nd Street Ste. #1
Ida Grove, IA 51445-9998
(712)364-3101

01/29/2015
Account Number 7608
Amount Due
0.00

Date Due
Upon Receipt

Amount Enclosed

CREDIT CARD TYPE,

#_
3 DIGIT CSV.

Rodney K Tegland
304 Willow St

EXPIRES

PO Box 401

AMOUNT APPROVED.

Odebolt, IA51458

NAME
SIGNATURE
PLEASE OETACH AND RETURN THE UPPER PORTION WITH YOUR PAYMENT

0-30
0.00

31-60
0.00

81;90

:--

oveffiO

0.00

0.00

Total:
-Ins Estimate:
^Balance:

$0.00
$0.00
$0.00

Rodney K Tegland
Date

; Tooth ":-':
Balance Forward

Description

Charges

Credits

Patient

Code

Rodney 'Rod'
Rodney 'Rod'

, tmm

08/31/2006
09/05/2006

Rodney 'Rod'

1 1/30/2006

Rodney 'Rod'
Rodney 'Rod1

Adjust

Oentrix Adjustment
Oentrix Adjustment

Rodney 'Rod'

Adjust

Denlrix Insurance Pay

01/10/2007

Rodney 'Rod'

Adjust

Dentrix Insurance Pay

02/01/2007

Rodney 'Rod1

Adjust

Dentrix Adjustment

1.62

196.78

03/01/2007
03/29/2007

Rodney 'Rod'
Rodney 'Rod1

Adjust
Adjust

Dentrix Adjustment

1.77
1.77

198.55
200.32

05/01/2007
05/31/2007

Rodney 'Rod'
Rodney 'Rod'

Adjust
Adjust

Dentrix Adjustment
Dentrix Adjustment

1.82

202.14

Dentrix Adjustment

1.85

06/28/2007

Rodney 'Rod'

Adjust

Dentrix Adjustment

1.85

203.99
205.84

07/31/2007
68/30/2007

Adjust
Adjust

Dentrix Adjustment

1.90

207.74
~209.67

Stmt

Dentrix Adjustment
Statement-Mat!

"1.93

10/09/2007

Rodney 'Rod'
Rodney 'Rod'
Rodney 'Rod'

11/19/2007

Rodney 'Rod'

Pay

Cash $132.67

MB

MA

58.00

135.00

03/12/2012

Rodney 'Rod'
Rodney 'Rod'
Rodney 'Rod'

24.00
0.00

159.00
159.00

03/12/2012

Rodney 'Rod'

Claim

03/12/2012

Rodney 'Rod'
Rodney 'Rod'

Pay

Pri Claim $82.00 Gomaco Godbersen Smith

Received 04/10/2012
Payment: $65.60
Cash $10.00

M 18

*umMmimmmm

08/31/2006

12/28/2006
01/10/2007

03/12/2012
03/12/2012

03/20/2012
03/29/2012
04/02/2012
04/02/2012

Rodney 'Rod'
Rodney 'Rod'
Rodney 'Rod'

04/02/2012

Rodney 'Rod'

mmmmm*

mar
mmm 18

Stmt

mmmmmmmmimmij

665,00
9.98

742.40
752.38

9.98

532.00

762.36
230.36

35.20

195.16

132.67

10.00
0.00

77.00

149.00
149.00

Statement-Electronic

mmm*
4

mmm

60.40
77.40

17.00

Adjust

18

27.00

Balance
33,40

mm*

64.00

213.00

109.00
31.00

322.00
353.00

04/02/2012

E-FILEDCode^
2015 FEB
footh05
Patient
Rodney 'Rod1
*
Rodney 'Rod'
OTM 18
1

04/02/2012

Rodney 'Rod1

Claim

Date
04/02/2012

10:46 AM SACDescription
- CLERK OF DISTRICT COURT
Charges

04/02/2012

Rodney 'Rod'

Pay

Pri Claim $1,168.00 Gomaco Godbersen Smith

Received 05/07/2012
Payment: $934.40
Cash $70.00

04/02/2012

Rodney 'Rod'

Stmt

Statement-lnPerson

04/10/2012

Rodney 'Rod'

Inspay

Insurance Payment for Claim 03/12/2012

Zdln

telinicalNote(Noiitllns)

04/17/2012

Rodney 'Rod'

04/17/2012

Rodney 'Rod'

04/17/2012

Rodney 'Rod'

* 2

04/17/2012

***
VlP

04/17/2012

Rodney 'Rod'
Rodney 'Rod'

05/01/2012

Rodney 'Rod'

05707/2012

Rodney 'Rod'

Stmt
InsPay

05/31/2012
07/03/2012

Rodney 'Rod'

Stmt

Statement-Electronic

Rodney 'Rod1
Rodney 'Rod'

Stmt "1
Adjust"

Statement-Electronic

Stmt

Statement-Electronic

07/30/2012

Rodney 'Rod'
Rodney 'Rod'

Adjust

08/30/2012

Rodney 'Rod'

Stmt ""

08/30/2012

Rodney 'Rod'

Adjust

10/01/2012

Rodney 'Rod'

10/01/2012
10/31/2012
1 1/61/2612

07/03/2012
07/30/2012

Claim

V&r

" / ;

165.00

Credits-

Balance.
518.00

799.00

1.3V7.00

70.00

1,247.00

65,60

1,181.40

0.00

1,181.40

90.00
136.00

1,271.40
1,407.40

625.00

2,032.40

Pri Claim $851.00 Gomaco Godbersen Smith

Received 05/07/2012
NO PAYMENT
Statement-Electronic
Insurance Payment for Claim 04/02/2012

Finance Charge

934.40

1,098.00

3.71

1,101.71

Finance Charge
Statement-Electronic

16.47

1,118.18

Finance Charge
Finance Charge

16.47

Adjust

16.47

1,134.65
1,151.12

Rodney 'Rod'

Stmt

Statement-Electronic

Rodney 'Rod'

Adjust
Stmt

16.77

1,167.89

Statement-Electronic

Adjust

Finance Charge

16.77

1,184.66

Statement-Electronic
Statement-Electronic

Finance Charge

11/27/2012

Rodney 'Rod1
Rodney 'Rod'

11/27/2012

Rodney 'Rod'

Slmt

12/27/2012

Rodney 'Rod'

Stmt

12/27/2012

Rodney 'Rod'

Adjust

1,201.68

Rodney 'Rod'
Rodney 'Rod1

Stmt

Finance Charge
Statement-Electronic

17.02

01/31/2013

Adjust

Finance Charge

17.52

1,219.20

Rodney 'Rod'

Stmt
Adjust

Statement-lnPerson
Bad Debt Write-Off

Rodney 'Rod'

Adjust

Finance Charge

01/31/2013
02/28/2013
02/28/2013
02/28/2013

Rodney 'Rod'

1,236.97
17.77

-17.77

0.00

E-FILED 2015 MAR 03 9:21 AM SAC - CLERK OF DISTRICT COURT

E-FILED 2015 MAR 04 10:05 AM SAC - CLERK OF DISTRICT COURT

IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY

Plaintiff(s),
L F NOLL INC
PO BOX 593
SIOUX CITY IA 51102

SMALL CLAIMS DIVISION

Case: 02811 SCSC015582

vs.
JUDGMENT ENTRY
Defendant(s),
ROD TEGLAND
304 WILLOW ST
ODEBOLT IA 51458
BRANDI TEGLAND
PO BOX 401
ODEBOLT IA 51458

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 $ 1236.97 with interest at the rate of 2.20 % from the 5th day
of February, 2015 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: $1300.00

1 of 2

E-FILED 2015 MAR 04 10:05 AM SAC - CLERK OF DISTRICT COURT

State of Iowa Courts

Case Number
SCSC015582
Type:

Case Title
L.F. NOLL, INC. V TEGLAND, RODNEY AND BRANDI
ORDER FOR JUDGMENT
So Ordered

Electronically signed on 2015-03-04 10:04:46

2 of 2