On June 25, 2024 a
Party Statement
was filed
involving a dispute between
Wallingford Endoscopy Center, Llc,
and
Iftikhar Ahmad,
for S10 - Small Claims - Small Claims - Collection - Medical Non-Hospital
in the District Court of New Haven County.
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WALLINGFORD ENDOSCOPY CENTER, LLC
vs
IFTIKHAR AHMAD
AFFIDAVIT OF DEBT
The undersigned, being duly sworn deposes and says
1 That I am the account manager for the collection of delinquent accounts
for the above named plaintiff and have personal knowledge of the facts
stated herein
2. Between the dates of 03/03/22 and 03/03/22 the plaintiff provided i
the defendant
(s) [ ] the defendant ( ) s minor children with MEDICAL
services on account for which there is a remaining balance due of
$1,650.0 pursuant to an express or implied contract to pay for said
services C1] The defendants are husband and wife and jointly and
severally liable for said services under C.G.S. Sec.46b-37
3 This action was commenced within six years of the date of the provision
of the above referred to services and is not barred under C.G.S.Sec.52-576
Ui The last date that services were provided was 03/03/2
[ ] The last date that a payment on account was made re said services
was 0/00/0 (i£ applicable)
4 The defendant
(s) has/have failed refused, and/or neglected to pay the
above remaining balance due the plaintiff
5 I know of no defense or offset to the plaintiff’s claim
SF
Kevin J. Brahm
CEE RD ST
Signe da oe
ay eworn to officer,
this day of
JOLR Ok Chap
Deborah L. Taylor
Notary Public
My Commission Expires 10/31/26
NEW-D90330
STATEMENT OF INDEBTEDNESS
WALLINGFORD ENDOSCOPY CENTER, LLC
RE IFTIKHAR AHMAD
PATIENT ACCOUNT # DOS BALANCE
AHMAD IFTIKHAR 20022 03/03/22 $1,650.00
TOTAL: $1,650.00
Document Filed Date
June 25, 2024
Case Filing Date
June 25, 2024
Category
S10 - Small Claims - Small Claims - Collection - Medical Non-Hospital
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WALLINGFORD ENDOSCOPY CENTER, LLC vs IFTIKHAR AHMAD AFFIDAVIT OF DEBT The undersigned, being duly sworn deposes and says 1 That I am the account manager for the collection of delinquent accounts for the above named plaintiff and have personal knowledge of the facts stated herein 2. Between the dates of 03/03/22 and 03/03/22 the plaintiff provided i the defendant (s) [ ] the defendant ( ) s minor children with MEDICAL services on account for which there is a remaining balance due of $1,650.0 pursuant to an express or implied contract to pay for said services C1] The defendants are husband and wife and jointly and severally liable for said services under C.G.S. Sec.46b-37 3 This action was commenced within six years of the date of the provision of the above referred to services and is not barred under C.G.S.Sec.52-576 Ui The last date that services were provided was 03/03/2 [ ] The last date that a payment on account was made re said services was 0/00/0 (i£ applicable) 4 The defendant (s) has/have failed refused, and/or neglected to pay the above remaining balance due the plaintiff 5 I know of no defense or offset to the plaintiff’s claim SF Kevin J. Brahm CEE RD ST Signe da oe ay eworn to officer, this day of JOLR Ok Chap Deborah L. Taylor Notary Public My Commission Expires 10/31/26 NEW-D90330 STATEMENT OF INDEBTEDNESS WALLINGFORD ENDOSCOPY CENTER, LLC RE IFTIKHAR AHMAD PATIENT ACCOUNT # DOS BALANCE AHMAD IFTIKHAR 20022 03/03/22 $1,650.00 TOTAL: $1,650.00