On February 26, 2024 a
Party Statement
was filed
involving a dispute between
Range Credit Bureau Inc.,
and
Shepard, Henry,
Shepard, Tina,
for Conciliation
in the District Court of Roseau County.
Preview
68-CO-24-22
Filed in District Court
State of Minnesota
2/26/2024 3:23 PM
State of Minnesota Conciliation Court
County of: Judicial District: Ninth
Roseau Court File Number:
Case Type: Conciliation
PLAINTIFF '8 STATEMENT OF CLAIM
Plaintiff #1 Plaintiff #2
Name: RANGE CREDIT BUREAU INC Name:
Address: PO BOX 706 Address:
City/State/Zip HEBBING MN 55746 City/State/Zip:
Defendant #1 Defendant #2
Name: HENRY SHEPARD Name: TINA SHEPARD
Address: PO BOX 225 Address: PO BOX 225
City/State/Zip: ROSEAU MN 56751 City/Stale/Zip ROSEAU MN 56751
[:l Check box if there are more than two plaintifi's 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? 2
a. Defendant # 1
Name: HENRY SHEPARD
IXI Individual (Person) |:] Business
If Defendant # I is an individual.'
i. I believe Defendant #1 is at least 18 years old.
Date of birth: 09/1 7/1 966 / |:| Unlmown.
ii. About military service:
I] Defendant #1 is in the military service
1:] Defendant #1 is not in the military service
IE Unknown.
b. Defendant # 2
Name: TINA SHEPARD
IZI Individual (Person) [Business
If Defendant # 2 is an individual.'
i. I believe Defendant #2 is at least 18 years old.
Plaintiffs Statement of Claim
CCT102 State ENG Rev 10/20 www.mncourts.govlforrns Page 1 of 3
68-CO-24-22
Filed in District Court
State of Minnesota
2/26/2024 3:23 PM
Date of birth: 1 0/19/1966 / D Unknown.
ii. About military service:
D Dcfendant # 2 is in the military service
D Defendant # 2 is not in the military service
X 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 appbz)
Money
EThe Defendant owes me $ 1,473.92 , plus filing fees and costs in the amount of
$ 80.00 , so my total claixn is for $ 1,553.92 (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 ATI'ACHED
"IN REGARDS TO INTEREST SEE MN STATUTE 334.01
**IN REGARDS TO NSF & CIVIL PENALTIES SEE MN STATUTE 604.113
**IN REGARDS TO HUSBAND AND WIFE LIABILITY SEE MN STATUTE 519.05
Properor
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).
Plaintiffs Statement of Claim
CCT102 State ENG Rev 10/20 www.mneourbgov/fonns Page 2 of 3
68-CO-24-22
Filed in District Court
State of Minnesota
2/26/2024 3:23 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 plaintifi' must sip 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 everythhig that I have stated in this document is true and
correct. § 358.116.
Minnjt.
Signature (Plaintifi' #1) Signature (Plaintift' #2)
OR DThere is only 1 plaintift'
DATE: 01/29/2024 DATE;
ST LOUIS
County and State where signer County and State where signed
S.H. CAUCCI
Name Name
PRESIDENT
Title, if any Title, if any
21 8-263-8886
Telephone Telephone
Date of birth Date of birth
legal@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 forln and include the information listed above.
Plaintiff's Statement of Claim
CCT102 State ENG Rev 10/20 www.mnoourts.govlfonns Page 3 of 3
68-CO-24-22
Filed in District Court
State of Minnesota
2/26/2024 3:23 PM
STATEMENT 0F CLAIMS ATTACHMENT
COUNTY: ROSEAU COUNTY
DEBTOR: HENRY R & TINA M SHEPARD 2ND LOC:
DEBTOR #2: TINA M SHEPARD
ADDRESS: PO BOX 225
ROSEAU MN 56751-0225
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 0F ACCOUNTS
CLIENT PRINCIPAL NSF FEE CIVIL PNL INTEREST COURT TOTAL DUE
MEDICAL IMAGING N $28.74 $0.00 $0.00 $15.53 $0.00 $44.27
MEDICAL IMAGING N $30.57 $0.00 $0.00 $16.28 $0.00 $46.85
MEDICAL IMAGING N $25.38 $0.00 $0.00 $11.64 $0.00 $37.02
MEDICAL IMAGING N $20.40 $0.00 $0.00 $8.91 $0.00 $29.31
MEDICAL IMAGING N $20.30 $0.00 $0.00 $8.40 $0.00 $28.70
MEDICAL IMAGING N $51.70 $0.00 $0.00 $13.61 $0.00 $65.31
MEDICAL IMAGING N $53.60 $0.00 $0.00 $11.27 $0.00 $64.87
MEDICAL IMAGING N $1,033.41 $0.00 $0.00 $124.18 $80.00 $1,237.59
TOTAL: $1,264.10 $0.00 $0.00 $209.82 $80.00 $1,553.92
THIS IS AN ATTEMPT TO COLLECT A DEBT.
ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
Document Filed Date
February 26, 2024
Case Filing Date
February 26, 2024
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68-CO-24-22 Filed in District Court State of Minnesota 2/26/2024 3:23 PM State of Minnesota Conciliation Court County of: Judicial District: Ninth Roseau Court File Number: Case Type: Conciliation PLAINTIFF '8 STATEMENT OF CLAIM Plaintiff #1 Plaintiff #2 Name: RANGE CREDIT BUREAU INC Name: Address: PO BOX 706 Address: City/State/Zip HEBBING MN 55746 City/State/Zip: Defendant #1 Defendant #2 Name: HENRY SHEPARD Name: TINA SHEPARD Address: PO BOX 225 Address: PO BOX 225 City/State/Zip: ROSEAU MN 56751 City/Stale/Zip ROSEAU MN 56751 [:l Check box if there are more than two plaintifi's 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? 2 a. Defendant # 1 Name: HENRY SHEPARD IXI Individual (Person) |:] Business If Defendant # I is an individual.' i. I believe Defendant #1 is at least 18 years old. Date of birth: 09/1 7/1 966 / |:| Unlmown. ii. About military service: I] Defendant #1 is in the military service 1:] Defendant #1 is not in the military service IE Unknown. b. Defendant # 2 Name: TINA SHEPARD IZI Individual (Person) [Business If Defendant # 2 is an individual.' i. I believe Defendant #2 is at least 18 years old. Plaintiffs Statement of Claim CCT102 State ENG Rev 10/20 www.mncourts.govlforrns Page 1 of 3 68-CO-24-22 Filed in District Court State of Minnesota 2/26/2024 3:23 PM Date of birth: 1 0/19/1966 / D Unknown. ii. About military service: D Dcfendant # 2 is in the military service D Defendant # 2 is not in the military service X 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 appbz) Money EThe Defendant owes me $ 1,473.92 , plus filing fees and costs in the amount of $ 80.00 , so my total claixn is for $ 1,553.92 (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 ATI'ACHED "IN REGARDS TO INTEREST SEE MN STATUTE 334.01 **IN REGARDS TO NSF & CIVIL PENALTIES SEE MN STATUTE 604.113 **IN REGARDS TO HUSBAND AND WIFE LIABILITY SEE MN STATUTE 519.05 Properor 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). Plaintiffs Statement of Claim CCT102 State ENG Rev 10/20 www.mneourbgov/fonns Page 2 of 3 68-CO-24-22 Filed in District Court State of Minnesota 2/26/2024 3:23 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 plaintifi' must sip 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 everythhig that I have stated in this document is true and correct. § 358.116. Minnjt. Signature (Plaintifi' #1) Signature (Plaintift' #2) OR DThere is only 1 plaintift' DATE: 01/29/2024 DATE; ST LOUIS County and State where signer County and State where signed S.H. CAUCCI Name Name PRESIDENT Title, if any Title, if any 21 8-263-8886 Telephone Telephone Date of birth Date of birth legal@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 forln and include the information listed above. Plaintiff's Statement of Claim CCT102 State ENG Rev 10/20 www.mnoourts.govlfonns Page 3 of 3 68-CO-24-22 Filed in District Court State of Minnesota 2/26/2024 3:23 PM STATEMENT 0F CLAIMS ATTACHMENT COUNTY: ROSEAU COUNTY DEBTOR: HENRY R & TINA M SHEPARD 2ND LOC: DEBTOR #2: TINA M SHEPARD ADDRESS: PO BOX 225 ROSEAU MN 56751-0225 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 0F ACCOUNTS CLIENT PRINCIPAL NSF FEE CIVIL PNL INTEREST COURT TOTAL DUE MEDICAL IMAGING N $28.74 $0.00 $0.00 $15.53 $0.00 $44.27 MEDICAL IMAGING N $30.57 $0.00 $0.00 $16.28 $0.00 $46.85 MEDICAL IMAGING N $25.38 $0.00 $0.00 $11.64 $0.00 $37.02 MEDICAL IMAGING N $20.40 $0.00 $0.00 $8.91 $0.00 $29.31 MEDICAL IMAGING N $20.30 $0.00 $0.00 $8.40 $0.00 $28.70 MEDICAL IMAGING N $51.70 $0.00 $0.00 $13.61 $0.00 $65.31 MEDICAL IMAGING N $53.60 $0.00 $0.00 $11.27 $0.00 $64.87 MEDICAL IMAGING N $1,033.41 $0.00 $0.00 $124.18 $80.00 $1,237.59 TOTAL: $1,264.10 $0.00 $0.00 $209.82 $80.00 $1,553.92 THIS IS AN ATTEMPT TO COLLECT A DEBT. ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.