On January 18, 2023 a
Party Statement
was filed
involving a dispute between
Flores, Johanna,
and
Brown, Tracy Starr,
Sisk, Richard Wayne,
for MOTOR VEHICLE ACCIDENT
in the District Court of Dallas County.
Preview
FILED
5/1/2023 11:38 AM
FELICIA PITRE
DISTRICT CLERK
DALLAS CO., TEXAS
Terri Kilgore DEPUTY
CAUSE N0. DC-23-00692
JOHANNA FLORES,
Plaintiff IN THE DISTRICT COURT
VS.
DALLAS COUNTY, TEXAS
TRACY STARR BROWN AND 14m JUDICIAL DISTRICT
RICHARD WAYNE SISK,
Defendants
PLAINTIFF JOHANNA FLORES’S NOTICE OF FILING AFFIDAVITS
TO: Defendants, Tracy Starr Brown and Richard Wayne Sisk, by and through attorney of record,
Caitlin M. Hodge, The Law Office of Chrysti Bryant, 8360 LBJ Freeway, Suite 410, Dallas,
Texas 75243
You are hereby notified that Plaintiff, Johanna Flores, has filed in the above entitled and
numbered cause, the following records, pursuant to Chapter 18 of the Texas Civil Practice &
Remedies Code and Rule 902 of the Texas Rules of Evidence:
1. Accident & Injury Chiropractic (Billing)
These records (or portions thereof) will be offered as evidence at the trial on the merits of this
case.
Plaintiff’s Notice of Filing Affidavits Page 1
DATE: May 1 . 20 23
Respectfilll __ul gnitted,
flak
7/
By:
David S kohm
State Bar No. 11658563
DAVID S. KOHM & ASSOCIATES
1414 W. Randol Mill Road, Suite 118
Arlington, Texas 76012
Tel: (817) 226-8100 Fax: (817) 200-01 11
Email: lit-efile@attorneykohm.com
ATTORNEYS FOR PLAINTIFF S
CERTIFICATE OF SERVICE
I hereby certify that on this lst day of May , 20 23 a true and
correct copy of the above and foregoing document was served via (as indicated below):
Via E—Filer Servicg
Caitlin M. Hodge
The Law Office of Chrystl Bryant
8360 LBJ Freeway, Suite 410
Dallas, Texas 75243
Tel: 972392—4550
Fax: 214-575—5575
KADallasEservicea’dlken CO
ATTORNEY FOR DEFENDANT
ATTORNEY FOR PLAINTIFFS
.
j
Kohm
1 Cause No
r )
)
Plaintiff.
u I
) IN THE DISTRICT COURT OF
J
) DALLAS COUNTY, TEXAS
)
. )
)
Defendant, )
AFFIDAVIT REGARDING MEDICAL EXPENSES
(Tex. Civ. Prac. & Rem. Code, Sec. 18.002(b—1)
Before me, the undersigned authority, on this day personally appeared DR.
10 LOU SAUCEDO, JR., D.C., who, being by me duly sworn, deposed as follows:
ll My nameis DR. LOU SAUCEDO, JR., D.C., I am of sound mind, capable of
making this affidavit, and personally acquainted with the facts herein
12
stated:
I am the custodian of billing records for ACCIDENT & INJURY CHIROPRACTIC.
13 Attached to this affidavit are records that provide an itemized statement of
the service(s)and charge(s) for the service(s) that ACCIDENT 8 INJURY
14 CHIROPRACTIC provided to JOHANNA FLORES from 09/21/2021 THRU 10/15/2021. The
attached records are a part of this affidavit.
15
The attached records arekept by ACCIDENT & INJURY CHIROPRACTIC in the
16 regular courseof business, and it was the regular course of business of
ACCIDENT & INJURY CHIROPRACTIC for an employee or representative of ACCIDENT
& INJURY CHIROPRACTIC with knowledge of the service provided, to_make the
17 record or to transmit information to be included in the record. The records
were made in the regular course of business at or near the time or reasonably
18 soon after the time the service was provided. The records are a duplicate of
the original.
19
The services provided were necessary and the amount charged for the
20
services was reasonable at the time and place that the services were
provided.
21 The totalamount paid for the services was $0.00 and the amount currently
unpaid but which ACCIDENT & INJURY CHIROPRACTIC has a right to be paid after
22 any adjustments or credits is $6,738.00. This amount may include a Records
Summary Report fee of $150.00.
23
24
—'-I—_
Records
25
SWORN TO AND SUBSCRIBED before me on the m day of 2023.
Notary Publ‘ic, State of Texas
Notary’s printed name and
commission expires : 05—13—2023
LILY SALINAS
My NotaryJD # 130225330
Ires May 13. 2023
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Automated Certificate of eService
This automated certificate of service was created by the efiling system.
The filer served this document via email generated by the efiling system
on the date and to the persons listed below. The rules governing
certificates of service have not changed. Filers must still provide a
certificate of service that complies with all applicable rules.
Taylor Brown on behalf of David Kohm
Bar No. 11658563
taylorb@attorneykohm.com
Envelope ID: 75172769
Filing Code Description: Affidavit
Filing Description: ACCIDENT & INJURY CHIROPRACTIC (BILLING)
Status as of 5/1/2023 3:35 PM CST
Associated Case Party: TRACYSTARRBROWN
Name BarNumber Email TimestampSubmitted Status
Caitlin MHodge chodge2@kemper.com 5/1/2023 11:38:42 AM SENT
Cyndie Bunker cyndie.bunker@kemper.com 5/1/2023 11:38:42 AM SENT
Associated Case Party: RICHARDWAYNESISK
Name BarNumber Email TimestampSubmitted Status
Caitlin MHodge chodge2@kemper.com 5/1/2023 11:38:42 AM SENT
Cyndie Bunker cyndie.bunker@kemper.com 5/1/2023 11:38:42 AM SENT
Document Filed Date
May 01, 2023
Case Filing Date
January 18, 2023
Category
MOTOR VEHICLE ACCIDENT
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FILED 5/1/2023 11:38 AM FELICIA PITRE DISTRICT CLERK DALLAS CO., TEXAS Terri Kilgore DEPUTY CAUSE N0. DC-23-00692 JOHANNA FLORES, Plaintiff IN THE DISTRICT COURT VS. DALLAS COUNTY, TEXAS TRACY STARR BROWN AND 14m JUDICIAL DISTRICT RICHARD WAYNE SISK, Defendants PLAINTIFF JOHANNA FLORES’S NOTICE OF FILING AFFIDAVITS TO: Defendants, Tracy Starr Brown and Richard Wayne Sisk, by and through attorney of record, Caitlin M. Hodge, The Law Office of Chrysti Bryant, 8360 LBJ Freeway, Suite 410, Dallas, Texas 75243 You are hereby notified that Plaintiff, Johanna Flores, has filed in the above entitled and numbered cause, the following records, pursuant to Chapter 18 of the Texas Civil Practice & Remedies Code and Rule 902 of the Texas Rules of Evidence: 1. Accident & Injury Chiropractic (Billing) These records (or portions thereof) will be offered as evidence at the trial on the merits of this case. Plaintiff’s Notice of Filing Affidavits Page 1 DATE: May 1 . 20 23 Respectfilll __ul gnitted, flak 7/ By: David S kohm State Bar No. 11658563 DAVID S. KOHM & ASSOCIATES 1414 W. Randol Mill Road, Suite 118 Arlington, Texas 76012 Tel: (817) 226-8100 Fax: (817) 200-01 11 Email: lit-efile@attorneykohm.com ATTORNEYS FOR PLAINTIFF S CERTIFICATE OF SERVICE I hereby certify that on this lst day of May , 20 23 a true and correct copy of the above and foregoing document was served via (as indicated below): Via E—Filer Servicg Caitlin M. Hodge The Law Office of Chrystl Bryant 8360 LBJ Freeway, Suite 410 Dallas, Texas 75243 Tel: 972392—4550 Fax: 214-575—5575 KADallasEservicea’dlken CO ATTORNEY FOR DEFENDANT ATTORNEY FOR PLAINTIFFS . j Kohm 1 Cause No r ) ) Plaintiff. u I ) IN THE DISTRICT COURT OF J ) DALLAS COUNTY, TEXAS ) . ) ) Defendant, ) AFFIDAVIT REGARDING MEDICAL EXPENSES (Tex. Civ. Prac. & Rem. Code, Sec. 18.002(b—1) Before me, the undersigned authority, on this day personally appeared DR. 10 LOU SAUCEDO, JR., D.C., who, being by me duly sworn, deposed as follows: ll My nameis DR. LOU SAUCEDO, JR., D.C., I am of sound mind, capable of making this affidavit, and personally acquainted with the facts herein 12 stated: I am the custodian of billing records for ACCIDENT & INJURY CHIROPRACTIC. 13 Attached to this affidavit are records that provide an itemized statement of the service(s)and charge(s) for the service(s) that ACCIDENT 8 INJURY 14 CHIROPRACTIC provided to JOHANNA FLORES from 09/21/2021 THRU 10/15/2021. The attached records are a part of this affidavit. 15 The attached records arekept by ACCIDENT & INJURY CHIROPRACTIC in the 16 regular courseof business, and it was the regular course of business of ACCIDENT & INJURY CHIROPRACTIC for an employee or representative of ACCIDENT & INJURY CHIROPRACTIC with knowledge of the service provided, to_make the 17 record or to transmit information to be included in the record. The records were made in the regular course of business at or near the time or reasonably 18 soon after the time the service was provided. The records are a duplicate of the original. 19 The services provided were necessary and the amount charged for the 20 services was reasonable at the time and place that the services were provided. 21 The totalamount paid for the services was $0.00 and the amount currently unpaid but which ACCIDENT & INJURY CHIROPRACTIC has a right to be paid after 22 any adjustments or credits is $6,738.00. This amount may include a Records Summary Report fee of $150.00. 23 24 —'-I—_ Records 25 SWORN TO AND SUBSCRIBED before me on the m day of 2023. Notary Publ‘ic, State of Texas Notary’s printed name and commission expires : 05—13—2023 LILY SALINAS My NotaryJD # 130225330 Ires May 13. 2023 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Automated Certificate of eService This automated certificate of service was created by the efiling system. The filer served this document via email generated by the efiling system on the date and to the persons listed below. The rules governing certificates of service have not changed. Filers must still provide a certificate of service that complies with all applicable rules. Taylor Brown on behalf of David Kohm Bar No. 11658563 taylorb@attorneykohm.com Envelope ID: 75172769 Filing Code Description: Affidavit Filing Description: ACCIDENT & INJURY CHIROPRACTIC (BILLING) Status as of 5/1/2023 3:35 PM CST Associated Case Party: TRACYSTARRBROWN Name BarNumber Email TimestampSubmitted Status Caitlin MHodge chodge2@kemper.com 5/1/2023 11:38:42 AM SENT Cyndie Bunker cyndie.bunker@kemper.com 5/1/2023 11:38:42 AM SENT Associated Case Party: RICHARDWAYNESISK Name BarNumber Email TimestampSubmitted Status Caitlin MHodge chodge2@kemper.com 5/1/2023 11:38:42 AM SENT Cyndie Bunker cyndie.bunker@kemper.com 5/1/2023 11:38:42 AM SENT