eForm 3.

1: Original Notice and Petition for aMoney Judgment

In the Iowa District Court for Sac County
Plaintiff( s)
Farmers State Bank
(Name)
401 Main Street. Lake View. IA
(Address)
(Name)
(Address)
vs.
Defendant( s)
Lane Pugh
(Name)
3274 365th Street, Auburn, IA 51433
(Address)
(Name)
(Address)
Original Notice and Petition
for a Money J udgment
To Defendant(s):
1. You are notified that Plaintiff(s) demand(s) from you the amount of $....;4..<.;,0;.;;.3_1;.;...9..;;..0 plus court
costs based on (state briefly the basis for the demand, not to exceed $5000):
Unpaid promissory note of $4,031.90
2. J udgment may be entered against you unless you file an Appearance and Answer within 20 days
of the service of the Original Notice upon you. J udgment may include the amount requested plus interest
and court costs.
3. You must electronically file the Appearance and Answer using the Iowa J udicial Branch Electronic
Document Management System (EDMS) at https:llwww.iowacourts.state.ia.us/EFile. unless you obtain
from the court an exemption from electronic filing requirements.
4. If your Appearance and Answer is filed within 20 days and you deny the claim, you will receive
electronic notification through EDMS of the place and time of the hearing on this matter.
5. If you electronically file, EDMS will serve a copy of the Appearance and Answer on Plaintiff(s) or on the
attorney(s) for Plaintiff(s). The Notice of Electronic Filing will indicate if Plaintiff(s) is (are) exempt from elec-
tronic filing, and if you must mail a copy of your Appearance and Answer to Plaintiff(s).
6. You must also notify the clerk's office of any address change.
15/ J oni Heun
Filing Plaintiff or Attomey
Farmers State Bank
Law firm, or entity for which filing is made, if applicable
eForm 3.1, page 1of 3
/5/ _
Second Plaintiff, if applicable
Law firm, or entity for which filing is made, if applicable
E-FILED 2014 SEP 08 1:51 PM SAC - CLERK OF DISTRICT COURT
401M3:in Street, LakeViE W " , IA 514::1)
Mailing address
1 1 2 - 6 5 7 ~8 5 2 5
Mailing address
TeleRhoR~number
fsbh.llaia..atelE CaIl. ret
Telephone number
Email address Email address
Additional email address, if applicable Additional email address, if applicable
eForm 3.1, page 2 of 3
E-FILED 2014 SEP 08 1:51 PM SAC - CLERK OF DISTRICT COURT