Plaintiff # I - perso n or company claiming the lawsuit
`American Family Mutual Insurance Com any
`c/o Benjamin C. Sorenson
`
`POA
`
`Address 220 S 6111 Street, #2050
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`City/S1a1e/Zip Minneapolis, MN 55402
`
`Plaintiff #2
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`Address
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`City/State/Zip
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`VERSUS
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`Defendant # I - perso n or company being sued
`Idowu Akingbala
`Address 11 264 Cedar Pointe Dr N
`Minnetonka, MN 55305
`
`City/State/Zip
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`Defendant #2
`
`Address
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`City/State/Zip
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`Defendant #3
`
`Address
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`City/State/Zip
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`I POA
`
`I POA
`
`POA
`
`POA
`
`Filed in Fourth Judicial District Court
`1/10/2018 2:16 PM
`Hennepin County, MN
`0
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`(/) m
`z
`0
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`27-CO-18-143
`
`STATEMENT OF CLAIM AND SUMMONS
`
`STATE OF MI NNESOTA
`COUNTY OF HENNEPIN
`
`FOURTH JUDICIAL DISTRICT
`CONCILIAT ION COU RT
`
`The Defendant(s) owe Plaintiff $ 13. 11 1.04, plus a $75.00, filing fee, for a
`, plus disbursements, because on or about,
`total of $ 13,186.04
`October 25. 2016. the following event occurred. Briefly describe the event
`below.
`
`Defendant Idowu Akingbala drove a motor vehicle owned by Defendant
`in such a negligent manner as to cause a collision with the motor vehicle
`owned by the Plaintiffs insured, Shawn Laska . As a result of the
`collision, Plaintiff was forced to pay out $13, 111.04 in property damage
`under a policy of insurance .. Plaintiff seeks reimbursement pursuant to its
`rights of subrogation.
`
`Our fi le number: 8067A-101 2
`
`Under oath, I swear the above statement of claim is true and correct to the
`best of my knowledge, and that the person(s) being sued are at least 18
`years of age, and not in th
`ilitary service.
`
`Signed _!}~~~:::::::-r_==--­
`T itle of Representative: Attorney for Plaintiff
`
`Daytime telephone: {612) 338-6000
`
`SUBSCRIBED AND SWORN TO BEFORE ME
`
`NOTARYSTAMPORCOURT
`SEAL
`
`Failure of defendant to appear at the hearing may
`result in a d efault judgment being entered for the
`plaintiff. Failure of the plaintiff to appear may
`result in dismissal of the action or a default Signature-l--;;r"'---'---=:.d--- - - '""=_,..-«....:...--'f
`judgment being entered in favor of the defendant Date
`on an counterclaim that has been asserted.
`- --'----''---
`OFFICE USE ONLY - DO NOT WRITE BELOW
`IMPORTANT NOTICE TO THE PARTIES
`You a re hereb summoned to a
`ear at the hearin of the above entitled case a t :
`TIME: _ ___ _____ _ ___ AM/PM
`
`Minneapolis - Room 320 City Hall - 350 South 5d• St, Mpls MN 55415 - 6121348-2713
`Minneapolis - Room 314 City Hall - 350 South 5lh St, Mpls MN 55415 - 612/348-2713
`
`D Certified
`D Secretary of State
`D Other - - -- - - - -
`
`DATE: _ ______ _ _ _ _____ _
`COURT
`CALEN DAR
`CLERK:
`CODE:
`- - -- -
`SPECIAL SERVICE
`D Personal Service
`Returned - -
`Returned
`- - -
`- -- - -
`0 Out of State - Indiv Returned - - - - -
`Returned
`- - - - -
`Returned
`- - - - -
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`Notice of Settlement
`The above-entitled case having been settled, the same may be and hereby is dismissed with my consent.
`
`Date: _ _ __ __ _ _
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`Plaintiff's Signature
`
`