On March 20, 2023 a
Party Statement
was filed
involving a dispute between
Gary Fishbein Dmd Pllc,
and
Dean Chapman,
for S25 - Small Claims - Small Claims - Contract - Other
in the District Court of Tolland County.
Preview
GARY FISHBEIN DMD PLLC SUPERIOR COURT
VS. J.D. AT TOLLAND
DEAN CHAPMAN FEBRUARY 4, 2023
AFFIDAVIT OF DEBT
I, OR GARY FISHBEIN, being duly sworn, depose and say the following:
1. I am D.D.S. for the plaintiff and I am over the age of eighteen and believe in the obligation of
the oath.
2. There is a balance due to plaintiff from defendant, DEAN CHAPMAN, on Account No. 235255
the sum of $205.80, which balance remains unpaid despite written demand.
3. Balance due is for dental services rendered to defendant(s) at defendant's request in
accordance with attached statement.
4. Plaintiff requests prejudgment interest be awarded in the amount of $34.96 calculated from
May 25, 2021 to the date hereof at the rate of 10% per annum pursuant to Conn. Gen. Stat
§37-3a as payment has been wrongfully withheld by defendant.
5. There is a total due to plaintiff of $240.76, including prejudgment interest of $34.96, which
sum remains unpaid despite demand
a
521809 DR GARY FISHBEIN
Subscribed and sworn to before me on . 2023.
2/4/2023 Notary Public
My Commission Expires:
SUE-ANN STEWART
NOTARY PUBUC
My Commission Expires Mar.31,2026
William G. Reveley & Associates, LLC
Attorneys At Law
P.O. Box 657, Vernon, CT 06066 •(860) 872-0686
Fax:(860) 870-7991 • Juris No. 423840
Document Filed Date
March 20, 2023
Case Filing Date
March 20, 2023
Category
S25 - Small Claims - Small Claims - Contract - Other
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GARY FISHBEIN DMD PLLC SUPERIOR COURT VS. J.D. AT TOLLAND DEAN CHAPMAN FEBRUARY 4, 2023 AFFIDAVIT OF DEBT I, OR GARY FISHBEIN, being duly sworn, depose and say the following: 1. I am D.D.S. for the plaintiff and I am over the age of eighteen and believe in the obligation of the oath. 2. There is a balance due to plaintiff from defendant, DEAN CHAPMAN, on Account No. 235255 the sum of $205.80, which balance remains unpaid despite written demand. 3. Balance due is for dental services rendered to defendant(s) at defendant's request in accordance with attached statement. 4. Plaintiff requests prejudgment interest be awarded in the amount of $34.96 calculated from May 25, 2021 to the date hereof at the rate of 10% per annum pursuant to Conn. Gen. Stat §37-3a as payment has been wrongfully withheld by defendant. 5. There is a total due to plaintiff of $240.76, including prejudgment interest of $34.96, which sum remains unpaid despite demand a 521809 DR GARY FISHBEIN Subscribed and sworn to before me on . 2023. 2/4/2023 Notary Public My Commission Expires: SUE-ANN STEWART NOTARY PUBUC My Commission Expires Mar.31,2026 William G. Reveley & Associates, LLC Attorneys At Law P.O. Box 657, Vernon, CT 06066 •(860) 872-0686 Fax:(860) 870-7991 • Juris No. 423840