judgment against lytton man in the amount $4,250.00

8/12/2019 Judgment Against Lytton Man in the Amount $4,250.00

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


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UNITED STATESPOSTAL SERVICE

Date: February 24 2014Brent M iller:The following is in respo nse to your F ebrua ry 21 2014 requ est for delivery informationon your Certif ied Mail item number 70101870000292550539. The delivery recordshowsthat this item was delive red on Fe bruary 24 2014 at 11:24 am in L Y T TO N IA50561. The re is no delivery signature onfile for this item.Than k you for selecting the Pos tal Se rvice for your mailing ne ed s. If you requireadditional assistance plea se contact your local Post O ff ice or postal representative.SincerelyUnited States Postal S ervice


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


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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 enteredit is necessary that a verification be filed. Plaintiff must file such verification at which point a judgmentwill be entered.

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


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State of Iowa Courts

Case Number Case TitleSCSC015407 IMT GROUP VS. BRENT MILLERType: OTHER ORDER

So Ordered

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

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Exhibit A

Affiants knowledge regarding Defendants military status is based upon the followinginformation, 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 whoadvised she thought he was living in Mallard, IA.

2. On April 23, 2013 the Defendant spoke with Adjuster Pete Pratkelis by phone andadvised 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 arelease.

4. On December 16, 2013 the Defendant spoke with Pete Pratkelis and Defendant agreed tomeet 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 threeattempts 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 CertifiedMail.

Based on the foregoing information, the affiant believes that the Defendant is not active in

the U.S. military.



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Statement of Amount Owed

Settlement reached on November 27, 2013, see attached release $ 750.00

Amount of Check which was

cashed on December 3, 2013 $5,000.00

Overpayment owed to IMT Group $4,250.00



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Claim No.: 2012Al171RELEASEThe undersigned, Brent A Miller, Individually ("CIa' ant" and ing o I galacknowledges payment to me o the sumo f ) , --:

( 7S-0J P in consideration o which payment I do hereby release, acquit a forever dischargeTony Heuton and Justin Heuton, Wadena Insurance Company and all other persons, ftrms andcorporations ("Releasees"), from any and all liability whatsoever, including all claims, demands, andcauses o action o 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 o said payment I hereby agree:1. That this Release agreement covers all injuries and damages, whether known or not andwhich may hereafter appear or develop arising from the matters above referred to.2. That the above sum is all that I will receive or 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 o a disputed claim, liability forwhich is expressly denied by the party and/or parties released (Releasees), and the payment othe above sum does not constitute an admission o liability on the part o any person or entity.4. That I am executing this release solely in reliance upon my knowledge, belief and judgmentand not upon any representations made by the party released or others in their behalf.5. That I have entered into this Release agreement o my own free will and that I have had theopportunity to consult with counsel o my own choice before entering into this agreement.6. That I will negotiate and satisfy any and all medical bills and liens o medical providers,insurers, workers compensation carriers, local, state or federal governments or agenciesthereof and all other persons or ftrms with liens or SUbrogation interests arising from thisaccident or from the proceeds o this settlement. The undersigned attorney guarantees the

agreement herein to negotiate and pay all liens and subrogation interests in this case out othe proceeds o 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 o action whatsoever by anyone on account othe injuries and/or damages sustained in the aforementioned accident and/or with respect tothe payment made pursuant to this release including any derivative claims such as those madeby or on behalfo any spouse or minor child.8. Undersigned, personally and through hislher legal representatives stipulates to the fact that asa condition o this settlement that the Releasee( s), their heirs, executors, administrators,agents, and assigns, and Wadena Insurance Company [hereinafter the Company] arematerially relying upon my/our assertion that I1we have not applied and am/are not eligible toreceive Medicare beneftts and/or Social Security disability beneftts as o the date osettlement. Undersigned agrees that I/we have not knowingly or unknowingly misrepresentedmy/our Medicare/Social Security disability beneftt status. Undersigned agrees to indemnifyand/or hold harmless the Releasee(s), their heirs, executors, administrators, agents and



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assigns, and the Company, for any loss ofMedicare benefits or for any recovery the Centersfor Medicare and Medicaid Services may pursue including, but not limited to, those related toSocial Security Disability. In addition, undersigned agrees personally and through hislherlegal representatives to release as part of this agreement any right to bring any possible futureaction under 1395y of the 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 agreementand 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 Ihave not sold, assigned, transferred, conveyed or otherwise disposed of any claim, demand oraction that is the subject of this Release agreement.THE TERMS OF THIS RELEASE AGREEMENT HAVE BEEN COMPLETELY READ ANDARE FULLY UNDERSTOOD AND ARE VOLUNTARILY ACCEPTED BY THEUNDERSIGNED FOR THE PURPOSE OF MAKING A FULL AND FINAL COMPROMISE,ADJUSTMENT, AND SETTLEMENT OF ANY AND ALL CLAIMS DISPUTED OROTHERWISE, THAT CLAIMANT MADE OR COULD HAVE MADE AGAINST THERELEASEES AS A RESULT OF THE INCIDENT AT ISSUE.Words and phrases herein shall be construed as in the singular or plural number, and asmasculine, feminine or neuter gender, according to the context.Dated at Lytton Iowa this ----.


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IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY

Plaintiff(s), SMALL CLAIMS DIVISIONIMT GROUP4445 CORPORATE DRIVE, ST 100WEST DES MOINES IA 50266

Case: 02811 SCSC015407

vs.

JUDGMENT ENTRYDefendant(s),

BRENT MILLER415 CHESTNUT STREETLYTTON IA 50561

The court file shows that the defendant has received proper notice and has failed to answer. Therelief is readily ascertainable from the Original Notice. Pursuant to Iowa Code Section 631.5(6), thedefendant 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 andcourt costs.

YOU ARE HEREBY NOTIFIED that you have a right to appeal the decision to the District Court bygiving written notice to the Small Claims Office within 20 days of the filing of this order. Filing Fee forappeal is $185.00. Appeal Bond is set in the amount of: $5,000.00

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State of Iowa Courts

Case Number Case TitleSCSC015407 IMT GROUP VS. BRENT MILLERType: ORDER FOR JUDGMENT

So Ordered

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

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judgment against lytton man in the amount $4,250.00

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