STATE OF MINNESOTA COUNTY OF ST. LOU

STATE OF MINNESOTA
COUNTY OF ST. LOUIS
Judicial District:
Sixth Judicial District
Court File Number:
69VI-CO-22-12
Case Type: Conciliation

STATEMENT OF
CLAIM AND SUMMONS
Plaintiff #1
John Kuznik
10 Nelson Drive, Silver Bay, MN 55614

Defendant #2
Natalyn Grace Isbell
1219 E. MADISON ST.
Ely, MN 55731
(LAST KNOWN ADDRESS)

PLAINTIFF’S STATEMENT OF CLAIM
1. I am filing this claim against Defendant for: (check all that apply)
The Defendant, Natalyn Grace Isbell, owes $4,189.20. I have a claim for this amount in December - 2018/2019 (month and year), the following happened (briefly describe) rent/fuel/damages.
Natalyn Isbell
Rent owed $1,342.61
Damage (share) $1,388.77
Unpaid fuel $886.50
Publication fees: $301.32
Filing Fee: $80.00
Attempted service of court notice: $60.00
Skip Tracer: $130.00
Date left March 2019
Total owed $4,189.20
2. I believe the person I am suing is at least 18 years old
Defendant #2 date of birth: 8-22-1997
4. 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.
I declare under penalty of perjury that everything that I have stated in this document is true and correct. Minn. Stat. 358.116.
Dated: January 17, 2022
Name: John Kuznik
10 Nelson Drive, Silver Bay, MN 55614, 218-226-4145
JohnKuznik@yahoo.com