On March 06, 2024 a
Statement of Claim Index #1
was filed
involving a dispute between
Fairview Health Services,
and
Burton, Kathrine G,
for Conciliation
in the District Court of Chisago County.
Preview
13-CO-24-131
Filed in District Court
State of Minnesota
3/6/2024 8:10 PM
STATE OF MINNESOTA CON CILIATION COURT
COIINTY 0F CHISAGO TENTH JUDICIAL DISTRICT
Court File Number:
Case Type: Conciliati011
PLAINTIFF'S STATEMENT OF CLAIM
Plaintiff #1 Plaintiff #2
Name: FAIRVIEW HEALTH SERVICES .
C/O RiVerView Law Office, PLLC
Address: 225 North Benton Drive, Suite 209 21313:."-'
C'1ty/S tate/Z'1p..
City/State/Zip: Saul: Rapids, MN 5637 9
VS.
Defendaiit #1 Defendant #2
Name: KATHRINE G BURTON Name:
.Address: 6096 ELM ST Address:
City/State/Zip: NORTH BRANCH, MN 55056 -
City/State/Zip:
Information about the Defendant
1. How many defendants are there? _1_
Name: KATHRTNE G BIRTON
jg" Individuel(Pereon)_____B1.13iness
fideféndarit #1 is an individual:
i. Ibelieve the defendantis atleast 18 years old.
Date of birth 1 1/20/1983 / Unlmoml
ii. About military service: -
Defendant is in militaty service WHDefendant is not in military service *QL Unknown
.!..
'.
infermetien ahotit the Claim
m" .
3:: 2. I am filhlg this, claim agahist Defemiantfor:
~
"
"""fll'lll-I'llllllllllll'WMT
Money
"Emilie Defendzmt owes Plaintiff 613,55 1627, 13111.9 filing fees
and.,eosts in the'.am.ount-.ot'i$80.00, so Plaintiff's total claim is for ~
'W'T"'
$3,596.27 (amount Defendant owes plus tiling fees and costs). Plaintiff has a claim in this amount because. on or about
03/29/2020 ~ 02/18/2022 the followh1g happened: Plaintiff 'previded Viihmble
goods and services to Defendant ami'Defendaht -
has failed to pay for the same. Reference No.: 2813456-
.;
,
.
xv-va- "Jar-lulu
3.. Iunderstand that if I dm not come to court on
my hearing date,- my case may lane-dismissed and [may have to pay money to the
.
Defendant on any counterclaim that has beam filed. .. . . _, ,
1
7
-'
Important! Each plaintiff eig11 the Statement of zm fonil~a11ci include the date signed, thename ofthe-stateand
coimty
where signed, an.cl previde the following infomatien: title, if any, telephone member, date of
birth, and await-address.
I declatve under penalty ot'pei'juiy that everything Ihave stated in this document is
hum ll Stat. §358.116.
DA'I'E:
I? [9/ /
'
Mar 6, 2024
,Minnesota
County {MEI/State where signed
/
Signature
v
Christilltt Sandy #03 9243 671211121 Kern #0392287
-
Molly W011 #0349562/1'e11g Lee #03 99029
320-229-2403 Amla Goettl #03 99861
Telephone Name
Attorneys f01' Plaintiff
contact@rive1viewnlaw.com
Email Address Title, if any
N/A
Date of birth
Document Filed Date
March 06, 2024
Case Filing Date
March 06, 2024
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13-CO-24-131 Filed in District Court State of Minnesota 3/6/2024 8:10 PM STATE OF MINNESOTA CON CILIATION COURT COIINTY 0F CHISAGO TENTH JUDICIAL DISTRICT Court File Number: Case Type: Conciliati011 PLAINTIFF'S STATEMENT OF CLAIM Plaintiff #1 Plaintiff #2 Name: FAIRVIEW HEALTH SERVICES . C/O RiVerView Law Office, PLLC Address: 225 North Benton Drive, Suite 209 21313:."-' C'1ty/S tate/Z'1p.. City/State/Zip: Saul: Rapids, MN 5637 9 VS. Defendaiit #1 Defendant #2 Name: KATHRINE G BURTON Name: .Address: 6096 ELM ST Address: City/State/Zip: NORTH BRANCH, MN 55056 - City/State/Zip: Information about the Defendant 1. How many defendants are there? _1_ Name: KATHRTNE G BIRTON jg" Individuel(Pereon)_____B1.13iness fideféndarit #1 is an individual: i. Ibelieve the defendantis atleast 18 years old. Date of birth 1 1/20/1983 / Unlmoml ii. About military service: - Defendant is in militaty service WHDefendant is not in military service *QL Unknown .!.. '. infermetien ahotit the Claim m" . 3:: 2. I am filhlg this, claim agahist Defemiantfor: ~ " """fll'lll-I'llllllllllll'WMT Money "Emilie Defendzmt owes Plaintiff 613,55 1627, 13111.9 filing fees and.,eosts in the'.am.ount-.ot'i$80.00, so Plaintiff's total claim is for ~ 'W'T"' $3,596.27 (amount Defendant owes plus tiling fees and costs). Plaintiff has a claim in this amount because. on or about 03/29/2020 ~ 02/18/2022 the followh1g happened: Plaintiff 'previded Viihmble goods and services to Defendant ami'Defendaht - has failed to pay for the same. Reference No.: 2813456- .; , . xv-va- "Jar-lulu 3.. Iunderstand that if I dm not come to court on my hearing date,- my case may lane-dismissed and [may have to pay money to the . Defendant on any counterclaim that has beam filed. .. . . _, , 1 7 -' Important! Each plaintiff eig11 the Statement of zm fonil~a11ci include the date signed, thename ofthe-stateand coimty where signed, an.cl previde the following infomatien: title, if any, telephone member, date of birth, and await-address. I declatve under penalty ot'pei'juiy that everything Ihave stated in this document is hum ll Stat. §358.116. DA'I'E: I? [9/ / ' Mar 6, 2024 ,Minnesota County {MEI/State where signed / Signature v Christilltt Sandy #03 9243 671211121 Kern #0392287 - Molly W011 #0349562/1'e11g Lee #03 99029 320-229-2403 Amla Goettl #03 99861 Telephone Name Attorneys f01' Plaintiff contact@rive1viewnlaw.com Email Address Title, if any N/A Date of birth