On January 16, 2021 a
Party Statement
was filed
involving a dispute between
Range Credit Bureau, Inc.,
and
Adkins, Tara,
for Conciliation
in the District Court of Carlton County.
Preview
09-CO-21-18
Filed in District Court
State of Minnesota
1/16/2021 4:11 PM
State of Minnesota Conciliation Court
County of: Judicial District: Sixth
Carlton Court File Number:
Case Type: Conciliation
PLAINTIFF'S STATEMENT OF CLAIM
Plaintiff #1 Plaintiff #2
Name: RANGE CREDIT BUREAU INC Name:
Address: PO BOX 706 Address :
City/State/Zip HIBBING MN 55746 City/State/Zip:
Defendant #1 Defendant #2
'
ame: TARA PETERSON ADKINS Name:
Address: 2344 LAC LABELLE RD Address:
City/State/zip: CARLTON MN 55718 City/State/Zip
D Check box if there are more than two plaintiffs or more than two defendants. List the
information for the other parties on the Additional Litigants Form, CCT702.
Information about the Defendant
1.How many defendants are there? 1
a.Defendant # 1
Name: TARA PETERSON ADKINS
Individual (Person) D Business
IfDefiandant # I is an individual:
i. Ibelieve Defendant #1 is at least 18 years old.
Date of birth: 07/31/1984 / D Unknown.
ii. About military service:
D Defendant #1 is in the military service
D Defendant #1 is not in the military service
E Unknown.
b. Defendant # 2
Name: _
Individual (Person) D Business
IfDefendant # 2 is an individual: _
i. I believe Defendant #2 is at least 18 years old.
Plaintiff's Statement of Claim
>
con 02 .
State ENG Rev 10/20 www.mncourts.govlforms Page 1 of 3
09-CO-21-18
Filed in District Court
State of Minnesota
1/16/2021 4:11 PM
Date of birth: / D Unknown.
ii. About military service:
D Defendant # 2 is in the military service
D Defendant # 2 is not in the military service
E Unknown.
If there are more than 2 defendants, use the Additional Litigants Form (CCT702).
Information about the Claim
2. I am filing this claim against Defendant for: (check all that apply)
Money
The Defendant owes me $ 1,381.05 , plus filing fees and costs in the amount of
$ 80.00 $
, so my total claim is for 1,461.05 (amount Defendant owes
plus filing fees and costs). I have a claim for this amount because in
MULTI (month and year), the following happened (briefly describe):
SEE ATTACHED
'
.
**IN REGARDS TO INTEREST SEE MN STATUTE 334.01
**|N REGARDS TO NSF & CIVIL PENALTIES SEE MN STATUTE 604.113
**|'NREGARDS TO HUSBAND AND WIFE LIABILITY SEE MN STATUTE 519.05
Property
D The Defendant has the following property that belongs to me (list property):
My property is valued at _$ . The filing fees and costs for this case are
$ .I want the court to order this property returned to me or make the
Defendant pay me $ (property's value plus the filing fees and costs).
Plaintiff's Statement of Claim
CCT102 State ENG Rev 10/20 www.mnoourtsgovlforms _ Page 2 of 3
09-CO-21-18
Filed in District Court
State of Minnesota
1/16/2021 4:11 PM
3. I understand that if I do not come to court on my hearing date, my case may be dismissed and
I may have to pay money to the Defendant on any counterclaim that has been filed.
Important! Each plaintiff must sign the Statement of Claim form and include the date signed,
the name of the state and county where signed, and provide the following information: title, if
any, telephone number, date of birth, and e-mail address.
I declare under penalty of perjury that everything that I have stated in this document is true and
correct. Minn. Stat. § 358.116.
-
.,-.-=
.1 A
Signature (Pla’ tiff #1)""‘""M~m -.
Signature (Plaintiff #2)
OR DThere is only l plaintiff
DATE: 01/14/2021 DATE;
ST LOU IS .
County and State Where Signed
'
County and State where signed
S.H. CAUCCI _
Name Name
PRESIDENT
Title; if any Title, if any
218-263-8886
Telephone Telephone
Date of birth Date of birth
admin@rcbcollections.com
Email Address Email Address
NOTE: If there are more than 2 plaintiffs, all of the other plaintiffs must sign the Statement of
Claim form and include the information listed above.
Plaintifi's Statement of Claim
CCT102 State ENG Rev 10/20 www.mncourtsgovlforma Page 3 of 3
09-CO-21-18
Filed in District Court
State of Minnesota
1/16/2021 4:11 PM
STATEMENT OF CLAIMS ATTACHMENT
COUNTY: CARLTON COUNTY
DEBTOR: Tara Peterson Adkins 07/32ND LOC:
DEBTOR.#2:
ADDRESS: 2344 Lac Labelle RD
CARLTON MN 55718—8225
NOTICE WAS MAILED TO THE DEFENDANT ADVISING OF COLLECTION ACCOUNTS AND/OR
DISHONORED CHECKS, SERVICE CHARGES AND PENALTIES. DEMAND IS HEREBY
MADE AS FOLLOWS:
LIST OF ACCOUNTS
CLIENT PRINCIPAL NSF FEE CIVIL PNL INTEREST" COURT TOTAL DUE
NORTHERN MN EYE C $147.74 I=$0.OO $0.00 $11.24 $80.00 $238.98
MINNESOTA POWER $1,151.29 $0.00 $0.00 $70.78 $0.00' $1,222.07
TOTAL: $1,299.03 $0.00 $0.00
'
$82.02 $80.00 $1,461.05
THIS IS AN ATTEMPT TO COLLECT A DEBT.
ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
Document Filed Date
January 16, 2021
Case Filing Date
January 16, 2021
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09-CO-21-18 Filed in District Court State of Minnesota 1/16/2021 4:11 PM State of Minnesota Conciliation Court County of: Judicial District: Sixth Carlton Court File Number: Case Type: Conciliation PLAINTIFF'S STATEMENT OF CLAIM Plaintiff #1 Plaintiff #2 Name: RANGE CREDIT BUREAU INC Name: Address: PO BOX 706 Address : City/State/Zip HIBBING MN 55746 City/State/Zip: Defendant #1 Defendant #2 ' ame: TARA PETERSON ADKINS Name: Address: 2344 LAC LABELLE RD Address: City/State/zip: CARLTON MN 55718 City/State/Zip D Check box if there are more than two plaintiffs or more than two defendants. List the information for the other parties on the Additional Litigants Form, CCT702. Information about the Defendant 1.How many defendants are there? 1 a.Defendant # 1 Name: TARA PETERSON ADKINS Individual (Person) D Business IfDefiandant # I is an individual: i. Ibelieve Defendant #1 is at least 18 years old. Date of birth: 07/31/1984 / D Unknown. ii. About military service: D Defendant #1 is in the military service D Defendant #1 is not in the military service E Unknown. b. Defendant # 2 Name: _ Individual (Person) D Business IfDefendant # 2 is an individual: _ i. I believe Defendant #2 is at least 18 years old. Plaintiff's Statement of Claim > con 02 . State ENG Rev 10/20 www.mncourts.govlforms Page 1 of 3 09-CO-21-18 Filed in District Court State of Minnesota 1/16/2021 4:11 PM Date of birth: / D Unknown. ii. About military service: D Defendant # 2 is in the military service D Defendant # 2 is not in the military service E Unknown. If there are more than 2 defendants, use the Additional Litigants Form (CCT702). Information about the Claim 2. I am filing this claim against Defendant for: (check all that apply) Money The Defendant owes me $ 1,381.05 , plus filing fees and costs in the amount of $ 80.00 $ , so my total claim is for 1,461.05 (amount Defendant owes plus filing fees and costs). I have a claim for this amount because in MULTI (month and year), the following happened (briefly describe): SEE ATTACHED ' . **IN REGARDS TO INTEREST SEE MN STATUTE 334.01 **|N REGARDS TO NSF & CIVIL PENALTIES SEE MN STATUTE 604.113 **|'NREGARDS TO HUSBAND AND WIFE LIABILITY SEE MN STATUTE 519.05 Property D The Defendant has the following property that belongs to me (list property): My property is valued at _$ . The filing fees and costs for this case are $ .I want the court to order this property returned to me or make the Defendant pay me $ (property's value plus the filing fees and costs). Plaintiff's Statement of Claim CCT102 State ENG Rev 10/20 www.mnoourtsgovlforms _ Page 2 of 3 09-CO-21-18 Filed in District Court State of Minnesota 1/16/2021 4:11 PM 3. I understand that if I do not come to court on my hearing date, my case may be dismissed and I may have to pay money to the Defendant on any counterclaim that has been filed. Important! Each plaintiff must sign the Statement of Claim form and include the date signed, the name of the state and county where signed, and provide the following information: title, if any, telephone number, date of birth, and e-mail address. I declare under penalty of perjury that everything that I have stated in this document is true and correct. Minn. Stat. § 358.116. - .,-.-= .1 A Signature (Pla’ tiff #1)""‘""M~m -. Signature (Plaintiff #2) OR DThere is only l plaintiff DATE: 01/14/2021 DATE; ST LOU IS . County and State Where Signed ' County and State where signed S.H. CAUCCI _ Name Name PRESIDENT Title; if any Title, if any 218-263-8886 Telephone Telephone Date of birth Date of birth admin@rcbcollections.com Email Address Email Address NOTE: If there are more than 2 plaintiffs, all of the other plaintiffs must sign the Statement of Claim form and include the information listed above. Plaintifi's Statement of Claim CCT102 State ENG Rev 10/20 www.mncourtsgovlforma Page 3 of 3 09-CO-21-18 Filed in District Court State of Minnesota 1/16/2021 4:11 PM STATEMENT OF CLAIMS ATTACHMENT COUNTY: CARLTON COUNTY DEBTOR: Tara Peterson Adkins 07/32ND LOC: DEBTOR.#2: ADDRESS: 2344 Lac Labelle RD CARLTON MN 55718—8225 NOTICE WAS MAILED TO THE DEFENDANT ADVISING OF COLLECTION ACCOUNTS AND/OR DISHONORED CHECKS, SERVICE CHARGES AND PENALTIES. DEMAND IS HEREBY MADE AS FOLLOWS: LIST OF ACCOUNTS CLIENT PRINCIPAL NSF FEE CIVIL PNL INTEREST" COURT TOTAL DUE NORTHERN MN EYE C $147.74 I=$0.OO $0.00 $11.24 $80.00 $238.98 MINNESOTA POWER $1,151.29 $0.00 $0.00 $70.78 $0.00' $1,222.07 TOTAL: $1,299.03 $0.00 $0.00 ' $82.02 $80.00 $1,461.05 THIS IS AN ATTEMPT TO COLLECT A DEBT. ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.