Claim by David Waddick
IN THE IOWA DISTRICT COURT FOR DUBUQUE COUNTY
ORIGINAL NOTICE
(Action for Money Judgment)
DAVID J. WADDICK
1937 Amelia Drive
Dubuque, IA 52ooi
Plaintiff,
vs.
Small Claim No.: SCSC
CITY OF DUBUQUE
5o W.~3~ Street
Dubuque, IA 52ooi
Defendant(s).
TO THE ABOVE NAMED DEFENDANT(S):
YOU ARE HEREBY NOTIFIED that the plaintiff(s) demand(s) from you the amount of $5,000.00 plus
interest, court costs and attorney's fees for failure to pay medical expenses relating to work related injury under Iowa
Code §4ii.
UNLESS YOU APPEAR by completing and filing the attached Appearance and Answer with the Clerk of
Court of Dubuque County within 20 days after service of this Original Notice upon you; judgment shall be rendered
against you upon Plaintiffs claim together with interest and court costs.
IF YOU DENY THE CLAIM AND APPEAR by filing the attached Appearance and Answer within 20 days
after service of this Original Notice upon you, you will then receive notification from the clerk's office of the place and
time assigned for hearing.
rn
~ o ~ BY ~ Q ;~~--
• - ~ James J. Roth of ~- ; ti~ ---+ ~,~
LLi "- r`~ -= ROTH LAW OFFICE, P.C. `T... `'' O + ;v
c:~ ~ rT~
-~ ~ ~ ~: i4oo University Ave., Suite D ~~-} n ~
~-~ ~ ._~ ~ Dubuque, IA 52ooi c~~ ~
L ~ '~7 ~ Phone: (563) 557-i6ii c-~-i w
L~- v ~'--) ~ Fax: (563) 557-9775-+~
~- ~ .~ ~ Email: iroth(c~rothlawdbq.com =~ ~ ,t-
~ JUDGMENT ENTRY ~~ ~
--i
TT IS HEREBY ORDERED THAT JUDGMENT BE ENTERED AGAINST THE DEFENDANT(S)
Plaintiff(s)
in the amount of $ with interest at the rate of %
from the day of , A.D., and attorney fees in the amount of
$ plus court cost in the amount of $ IT IS FURTHER ORDERED that the foregoing
judgment be paid at the rate of $ per
Dated this day of , A.D.,
Authority: Chapter 631,1985 code of Iowa, as amended-
prescnbed bythe Supreme Court Be sure to attach
to this notice and appearance an answer fonn as prescribed
by the Supreme Court (Fonn 9-i). (Judge) (Magistrate) (Clerk)
~'
IN THE IOWA DISTRICT COURT IN AND FOR DUBUQUE COUNTY
DANIEL J. WADDICK
Plaintiff,
vs.
CITY OF DUBUQUE ,
Defendant.
Small Claims NO. SCSC
APPEARANCE AND ANSWER OF
DEFENDANTS
I HEREBY ENTER MY APPEARANCE AND DENY THE CLAIM of the Plaintiff for the
following reason:
Dated this day of ,
Defendant(s) name
Phone Number: _
Date of Birth:
By:
Attorney for Defendant
(Attorney Address)
I HEREBY ENTER MY APPEARANCE AND ADMIT that the Plaintiff s claim
herein is justly due and owing by me. I hereby confess judgment for said
amount plus interest and costs and authorize judgment to be entered
accordingly. Please set up a payment plan for $ I understand that
these payments are to be made directly to the Plaintiff and not through the
Clerk of Court. I would like to start making payments on