Marie Annette Confair vs Total Sanitation, 70-CO-22-3823, 24032022_Statement of Claim_0 (Minnesota State, Scott County, District Court Mar. 24, 2022)
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State of Minnesota
`County of:
`
`Conciliation Court
`
`Judicial District:
`Court File Number: 70 “CO ” 3i 9535
`Conciliation
`Case Type:
`PLAINTIFF'5 STATEMENT OF CLAIM
`Plaintiff #2
`Name:
`Address:
`
`’2
`
`Plaintiff #1
`Name: magpie, Coflg‘qcr
`Address: 331 $9
`EWlQV Dan AV? \’\
`m D is W‘ H 4:54 \\
`City/State/Zip‘
`Defendant #1
`Name: Valve“ 31“ \ him) V)
`Address: 7gOL‘ Q‘— RC\
`\0 \
`Slag Kane 8 m V\ 5537?
`City/State/Zip:
`City/State/Zip
`E] Check box if there are more than two plaintiffs or more than two defendants. List the
`information for the other parties on the Additional Litigams Farm, CCT702.
`Information about the Defendant
`1. How many defendants are there?
`a. Defendant # 1
`TOTQi 39h \At 0368 V3
`Name:
`D Individual (Person) E] Business
`IfDefendant # l is an individual:
`i. I believe Defendant #1 is at least 18 years old.
`Date of birth:
`[:3 Unknown.
`/
`ii. About military service:
`E] Defendant #1 is in the military service
`[:1 Defendant #1 is not in the military service
`I] Unknown.
`b. Defendant # 2
`
`C ity/State/Zip:
`Defendant #2
`Name:
`Address:
`
`‘
`
`‘
`
`I
`
`F'
`ism-c, Co _
`3,4234"
`o"Il’ll'nne u”
`Sat
`MAP 2 4
`
`.
`
`2022
`
`Name:
`[3 Individual (Person)
`[:1 Business
`IfDefendant # 2 is an individual:
`1. I beheve Defendant #2 18 at least 18 years old.
`
`RECEIVED
`
`MAR 2 l, ZULZ
`
`SCOTT COUNTY COURTS
`
`Plaintiff's Statement of Claim
`CCT102
`State
`ENG
`
`Rev 10/20
`
`www.mncourts.gov/forms
`
`Page 1 of 3
`
`
`
`/ E Unknown.
`Date of birth:
`ii. About military service:
`El Defendant # 2 is in the military service
`[:1 Defendant # 2 is not in the military service
`I] Unknown.
`If there are more than 2 defendants, use the Additional Litigants Form (CCT702).
`
`‘
`
`K
`
`, plus filing fees and costs in the amount of
`
`/é; (90 _(amount Defendant owes
`
`Information about the Claim
`2. I am filing this claim against Defendant for: (check all that apply)
`Money
`i 00 U
`jgThe Defendant owes me 39
`”(ZL/L/
`__ 9 so my total claim is for
`$
`/ 2 /
`plus filing fees and costs). I have a claim for thisainount because1n
`(month and year),
`the following happened (briefly describe):
`fflv drive (ADOK/ and CVQCkKai
`argue, on
`47 m (/[MCS Pail lore!“ 9/ ho“) (ENC/4w
`(/MCK
`barama (“>an 5:920 A;see:
`[4&8 MOM)
`-
`C/acl: a// We .1.) cm;
`a CVOS5 %8 (WU4(9ch 01C
`“Ear7%iei/
`e F:
`(/l/H/{L (2) a7
`<a/Q‘l‘daas
`[7/
`
`ban/fallen
`
`Property
`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
`
`Plaintifi"s Statement of Claim
`CCTt 02
`State
`ENG
`
`Rev 10/20
`
`www.mncourts.gov/forms
`
`Page 2 of 3
`
`
`
`3.
`
`$
`
`. I want the court to order this property returned to me or make the
`Defendant pay me 35
`(property's value plus the filing fees and costs).
`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 plaintiff must sign the Statement ofClaim 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 everything that I have stated in this document is true and
`correct. Minn. Stat. § 358.116.
`
`~.m/U
`
`\
`
`9
`
`fl
`Signature (Plaintiff #1)
`DATE: 3:24—91
`M 77
`ZZCM
`County and State where signed
`
`flier/e
`Name
`
`(iomfqm
`
`Signature (Plaintiff #2)
`OR [:lThere is only 1 plaintiff
`DATE:
`
`County and State where signed
`
`Name
`
`Title, if any
`
`Telephone
`
`Date of birth
`
`\ (
`
`@/2‘ 52253 90
`wait ~98
`(0174(‘1/ MCI/(‘5 dé MC“
`Email Address
`Email Address
`NOTE: If there are more than 2 plaintiffs, all of the other plaintiffs must sign the Statement of
`Claim form and include the information listed above.
`
`Title, if any
`
`Telephone
`
`Date of birth
`
`Plaintiff's Statement of Claim
`CCT102
`State
`ENG
`
`Rev 10/20
`
`www.mncourtsgov/forms
`
`Page 3 of 3
`
`
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