On July 07, 2021 a
Party Discovery
was filed
involving a dispute between
Rose, Daniel,
and
Hall, Bridgette,
for Personal Injury
in the District Court of Goodhue County.
Preview
25-CV-21-1345
Filed in District Court
State of Minnesota
6/28/2022 8:40 PM
City of Cannon Falls Ambulancg ACCOUNT # STATEMENT DATE AMOUNT DUE
918 River Road CANNON FALLS, MN 55009—1447 048970 07/03/2019 $1,719.00
(551) 463-3867
Tax ID: 416005032
GUARDIAN OF ARYAH ROSE CITY OF CANNON FALLS AMBULANCE
1484 WALNUT ST 918 RIVER ROAD
PRESCOTT, WI 54021 CANNON FALLS, MN 55009—1447
IIII'IIIIIHIHIIIIIIIIIHIHlII IIIIIIllIIIIIIll”IllIll]lll[HIIIIIIIIIHIIIIIIIIII
I
I.
Please provIde your Insurance informanon on the back side and retum Io our offlce
PLEASE RETURN TOP PORTION WITH YOUR PAYMENT
INSURANCE INFORMATION NEEDED
Patient
V
Invoice V
'
Description Charges Payments! 33'3“”
Adjustm ms
. -
.
.
Responsibility
CAN3064 06/25/2019 Service Provided by City of
Cannon Falls Ambulance
Patient:Guardian of Ann—
Marie Aryah Rose
Transported from: Scene of
accident or acute event
Transported to: MCHS -
CANNON FALLS
Currently billing:Self Pay as
of 07/03/2019
(A0425) Mileage $69.00
(3.00 @ $23.00)
(A0427) ALS Emergency $1,650.00
$1,719.00
Current 31 - 60 Days 61 - 90 Days 91 - 120 Days Over 120 Days ~
$1,719.00 0.00 0.00 0.00 0.00 Outstandinq Balance: $1,719.00
Total Due: $1,719.00
Messages
We were unable to locate your insurance information. Please complete the back side and return to our
office. You may also call us with your insurance information at 651-463-3867 or 1—800—474-3128.
STATEMENT CREATED: 07/03/2019
STATEMENT DATE: 07/03/2019 ACCOUNT!/048970STATEMENT #7GWA-XEBB-WEJE-BWE3PAGE 1of1
Document Filed Date
June 28, 2022
Case Filing Date
July 07, 2021
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
25-CV-21-1345 Filed in District Court State of Minnesota 6/28/2022 8:40 PM City of Cannon Falls Ambulancg ACCOUNT # STATEMENT DATE AMOUNT DUE 918 River Road CANNON FALLS, MN 55009—1447 048970 07/03/2019 $1,719.00 (551) 463-3867 Tax ID: 416005032 GUARDIAN OF ARYAH ROSE CITY OF CANNON FALLS AMBULANCE 1484 WALNUT ST 918 RIVER ROAD PRESCOTT, WI 54021 CANNON FALLS, MN 55009—1447 IIII'IIIIIHIHIIIIIIIIIHIHlII IIIIIIllIIIIIIll”IllIll]lll[HIIIIIIIIIHIIIIIIIIII I I. Please provIde your Insurance informanon on the back side and retum Io our offlce PLEASE RETURN TOP PORTION WITH YOUR PAYMENT INSURANCE INFORMATION NEEDED Patient V Invoice V ' Description Charges Payments! 33'3“” Adjustm ms . - . . Responsibility CAN3064 06/25/2019 Service Provided by City of Cannon Falls Ambulance Patient:Guardian of Ann— Marie Aryah Rose Transported from: Scene of accident or acute event Transported to: MCHS - CANNON FALLS Currently billing:Self Pay as of 07/03/2019 (A0425) Mileage $69.00 (3.00 @ $23.00) (A0427) ALS Emergency $1,650.00 $1,719.00 Current 31 - 60 Days 61 - 90 Days 91 - 120 Days Over 120 Days ~ $1,719.00 0.00 0.00 0.00 0.00 Outstandinq Balance: $1,719.00 Total Due: $1,719.00 Messages We were unable to locate your insurance information. Please complete the back side and return to our office. You may also call us with your insurance information at 651-463-3867 or 1—800—474-3128. STATEMENT CREATED: 07/03/2019 STATEMENT DATE: 07/03/2019 ACCOUNT!/048970STATEMENT #7GWA-XEBB-WEJE-BWE3PAGE 1of1