Claytor, Sheila (2) ��� y
State of Minnesota � Conciliation Court ;
County � �`�? ��;��, .Judicial District Case No.
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STATEMENT OF CLAIM AND SUMMONS ��C�Il�/�� ''
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Plaintiff#1 Plaintiff#2 I ;
Name ��� ^ r = ;�� P Name ��
Address �� � � � � L Address C �
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City/State/Zip S City/State/Zip � � �
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VS E VS �
Defendant#1 ., %�-, Ji'.�1+C��- P Defendant #2 0
Name ��{6� IS5 ri; A7�1YY1 R Name � , (���i cJ� ;
Address�;� t{C�OC'� •�'til(�AaID�CT(` � I�� N Address � � ; ���� 3�
ST. ��t�� l�1� 1 T � ���L �� �
City/State/Zip City/State/Zip �
PLAINTIFF'S STATEMENT OF CLAIM
❑ 1. The Defendant(s)owe(s) me $ , plus filing fees and costs of$ , for a total
of$ because(state what happened and when it happened):
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❑ 2. The Defendant(s)has/have tMe followmg property that belongs to me(list property),
\f�,,�A 4�'C�� J f�.l IL� ���-I���1� �J�1 � � valued at
$ � �:;�;,�` , plus filing fees and costs of$ , for a total of$ ;
I want the Court to order this property returned to me or make the Defendant(s)pay me money for the value of '
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the property. ,
3. I believe the person(s) I am suing is/are at least 18 years old and not in the military service.
Defendant#1 date of birth Defendant#2 date of birth +
4. I understand that if I do not come to court on my hearing date, my case will be dismissed and I may have to pay �
money to the Defendant(s)on any counterclaim that has been filed. �
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NOTARY STAMP OR COURT SEAL SWORN TO B FORE ME ON: THE ABOVE STATEMENT OF CLAIM IS TRUE AND
� � CORRECT TO T EST OF M NOWLE G '
Date:�-- ` Sigr.ature: ,f Gyt'��Z� I
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K % Name: � ����(_-�T l�l���� 1
Signatu : � -�----
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Telephone:� �1/5�— �`f � �.� �
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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: Plaintiff's Signature: �
SUMMONS: IMPORTANT NOTICE TO THE PARTIES i
You must come to court for a hearing on at _.m. at
I
Date Time �
Location/Address �
If you do not come to court for this hearing,you ma,y lose the case and have to pay money to the other party. !
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Dated: Court Adininistrator/Deputy '
CCT102 State ENG Rev 6/10 www.mncourts.gov/forms Page 1 of 3
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July 29th, 2014
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ADDENDUM ' � '
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This is to notify you that I, Sheila Claytor am the sole owner of the 1996 Nissan Maxima that was seized.
My son Derek Claytor's name was added to the title because he had a valid driver's license. Due to
severe mobility issues from an underlying condition, I am unable to drive. Derek and I agreed that he
would transport me to needed medical appointments and to other places as requested. I have a chronic
medical condition that requires me to go to the Mayo Clinic in Rochester on a regular basis. This car was
purchased for the sole purpose to assist me in getting to these appointments. It is through no fault of
my own that the car was seized, due to the alleged charges that are still pending that Derek was driving
while under the influence. I was not aware that the car keys were in his possession at the time of the
incident. I take no responsibility for his actions and would like to have the car returned to me before the
deadline so that I will not be in jeopardy of loosing it. I do have another person who is willing to take
over these duties and am desperately in need of a car so that I can move forward. There is no
alternative at this time due to my disability status and am unable to afford another car. So again, I am
requesting that the property be released to me ASAP as it is critical that I have transportation so that I
can continue making all of my appointments to ensure that I get the necessary medical treatments to
continue to improve my health.
I thank you for your consideration
Sin ely � , �
��1,�,�-"" �
Sheila Claytor
�
10 East 4th St.#708
St. Paul MN, 55101
651-340-6731