On December 09, 2019 a
Summons
was filed
involving a dispute between
Servicemaster Of St. Cloud,
and
Kube, Adam J,
Kube, Krystal M,
for Conciliation
in the District Court of McLeod County.
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12/9/2019 3:21 PM Scanned b McLeod County
File in District Court
State of Minnesota
DEC >
9 2mg
State of Minnesota Conciliation Court
county Ofi Judicial District: First
MCLeOd Court File Number: Hg/i 12/59!
’ lg 5
Case Type: Conciliation
STATEMENT OF CLAIM AND SUMMONS
Plaintiff #1 Plaintiff #2
Name: SERVICEMASTER OF ST CLOUD amei
AddreSS: P0 BOX 608
City/State/Zip ST CLOUD / MN / 56302 City/State/Zip:
Defendant #1 Defendant #2
Name: ADAM J. KUBE Name: KRYSTAL M. KUBE
Address: 1667 H|DDEN TRL Address: 1667 H|DDEN TRL
City/State/Zip: MAYER / MN / 55360 City/State/Zip MAYER / MN / 55360
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.
PLAINTIFF'S STATEMENT 0F CLAIM
l. I am filing this claim against Defendant for: (check all that apply)
X The Defendant owes me $ ,
plus filing fees and costs in the amount of
$ 70.00 ,
so my total claim is for 15,070.00 (amount Defendant owes
plus filing fees and costs). I have a claim for this amount because in
December, 201 8 (month and year), the following happened (briefly describe):
We were called to do fire & content mitigation services at the property located at:
3445UNFISH LANE, WINSTEAD, MN. The defenadants were renting the house and we
were hired to clean their personal property that was affected by smoke damage. The
defendants insurance adjuster confirmed with us that the payment covering our invoice
was sent to them, but we remain unpaid for our services.
D The Defendant has the following property that belongs to me (list property):
CCT1 02 State ENG Rev 2/1 7 www.mncourts.gov/forms Page 1 of 3
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).
2. I believe the person I am suing is at least l8 years old.
Defendant #1 date of birth: / D Unknown.
Defendant #2 date of birth: / D Unknown.
Ifa defendant is a business, leave this section blankfor that defendant.
3. About military service:
Defendant #1 is D in the military service/ D is not in the military service D Unknown.
Defendant #2 is D in the military service D / is not in the military service D Unknown.
Ifa defendant is a business, leave this section blankfor that defendant.
4. 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.
I declare under penalty of perjury that everything that I have stated in this document is true and
correct. Minn. Stat. § 358.1 16.
Important! Each plaintiff must sign the Statement ofClaim and Summons 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, and e-mail address.
v
Siéfiature
STEARNS _
Name: md' penny cl
County and State where s1gned
Address: PO BOX 608
City/State/Zip: ST CLOUD / MN / 56302
Telephone: 320-252-5622
E-mail address: smaster@svmps.com
CCT102 State ENG Rev 2/1 7 www.mncourts.gov/forms Page 2 of 3
SUMMONS: IMPORTANT NOTICE TO THE PARTIES
You are summoned to appear at the hearing of the above-entitled case. See the attached Notice
of Hearing for time and location. If not attached, call Conciliation Court in McLeod
County.
If the defendant does not appear at the hearing, the plaintiff may win this case by default,
which means the plaintiff could be awarded a money judgment against the defendant.
The judgment could include the amount the plaintiff requested in the Statement of Claim
as well as other fees and costs approved by a judicial officer.
If the plaintiff does not appear at the hearing, this case may be dismissed. If the
defendant has filed a counterclaim, then a default judgment could be entered against the
plaintiff.
The Defendant may bring a counterclaim against the Plaintiff. A counterclaim must be filed at
least five days before the Conciliation Court hearing. For forms, instructions, and more
information, see Information About Conciliation Court (court form CCTl 01) on the court’s
website starting at www.mncourts.gov/forms.
NOTICE 0F SETTLEMENT
The above-entitled case has been settled, and is dismissed with my consent.
Important! Each plaintiff who has settled the case must sign and date this “Notice of
Settlement” section.
Dated:
Signature
CCT102 State ENG Rev 2/17 www.mncourts.gov/forms Page 3 of 3
Document Filed Date
December 09, 2019
Case Filing Date
December 09, 2019
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12/9/2019 3:21 PM Scanned b McLeod County File in District Court State of Minnesota DEC > 9 2mg State of Minnesota Conciliation Court county Ofi Judicial District: First MCLeOd Court File Number: Hg/i 12/59! ’ lg 5 Case Type: Conciliation STATEMENT OF CLAIM AND SUMMONS Plaintiff #1 Plaintiff #2 Name: SERVICEMASTER OF ST CLOUD amei AddreSS: P0 BOX 608 City/State/Zip ST CLOUD / MN / 56302 City/State/Zip: Defendant #1 Defendant #2 Name: ADAM J. KUBE Name: KRYSTAL M. KUBE Address: 1667 H|DDEN TRL Address: 1667 H|DDEN TRL City/State/Zip: MAYER / MN / 55360 City/State/Zip MAYER / MN / 55360 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. PLAINTIFF'S STATEMENT 0F CLAIM l. I am filing this claim against Defendant for: (check all that apply) X The Defendant owes me $ , plus filing fees and costs in the amount of $ 70.00 , so my total claim is for 15,070.00 (amount Defendant owes plus filing fees and costs). I have a claim for this amount because in December, 201 8 (month and year), the following happened (briefly describe): We were called to do fire & content mitigation services at the property located at: 3445UNFISH LANE, WINSTEAD, MN. The defenadants were renting the house and we were hired to clean their personal property that was affected by smoke damage. The defendants insurance adjuster confirmed with us that the payment covering our invoice was sent to them, but we remain unpaid for our services. D The Defendant has the following property that belongs to me (list property): CCT1 02 State ENG Rev 2/1 7 www.mncourts.gov/forms Page 1 of 3 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). 2. I believe the person I am suing is at least l8 years old. Defendant #1 date of birth: / D Unknown. Defendant #2 date of birth: / D Unknown. Ifa defendant is a business, leave this section blankfor that defendant. 3. About military service: Defendant #1 is D in the military service/ D is not in the military service D Unknown. Defendant #2 is D in the military service D / is not in the military service D Unknown. Ifa defendant is a business, leave this section blankfor that defendant. 4. 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. I declare under penalty of perjury that everything that I have stated in this document is true and correct. Minn. Stat. § 358.1 16. Important! Each plaintiff must sign the Statement ofClaim and Summons 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, and e-mail address. v Siéfiature STEARNS _ Name: md' penny cl County and State where s1gned Address: PO BOX 608 City/State/Zip: ST CLOUD / MN / 56302 Telephone: 320-252-5622 E-mail address: smaster@svmps.com CCT102 State ENG Rev 2/1 7 www.mncourts.gov/forms Page 2 of 3 SUMMONS: IMPORTANT NOTICE TO THE PARTIES You are summoned to appear at the hearing of the above-entitled case. See the attached Notice of Hearing for time and location. If not attached, call Conciliation Court in McLeod County. If the defendant does not appear at the hearing, the plaintiff may win this case by default, which means the plaintiff could be awarded a money judgment against the defendant. The judgment could include the amount the plaintiff requested in the Statement of Claim as well as other fees and costs approved by a judicial officer. If the plaintiff does not appear at the hearing, this case may be dismissed. If the defendant has filed a counterclaim, then a default judgment could be entered against the plaintiff. The Defendant may bring a counterclaim against the Plaintiff. A counterclaim must be filed at least five days before the Conciliation Court hearing. For forms, instructions, and more information, see Information About Conciliation Court (court form CCTl 01) on the court’s website starting at www.mncourts.gov/forms. NOTICE 0F SETTLEMENT The above-entitled case has been settled, and is dismissed with my consent. Important! Each plaintiff who has settled the case must sign and date this “Notice of Settlement” section. Dated: Signature CCT102 State ENG Rev 2/17 www.mncourts.gov/forms Page 3 of 3