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Case 4:22-cv-00305-O Document 1-3 Filed 04/13/22 Page 1 of 4 PageID 10
UN DE ERED THIS Lr OF ou) a LHD 

 

7s 

Vor I L CIVIL ew INITIALS: baa En] CAUSE NO. JP01-22-5C00015364 SERVICE COPY 

ER NEAR ME § IN THE JUSTICE COURT PLAINTIFF § 

VS. § PRECINCT ONE § 

AETNA HEALTH AND LIFE INSURANCE § TARRANT COUNTY, TEXAS 

COMPANY DEFENDANT | § 

CITATION (SMALL CLAIMS OR DEBT CLAIM CASE) 

THE STATE OF TEXAS | 

TO: AETNA HEALTH AND LIFE INSURANCE COMPANY, SERVE REGISTERED AGENT CT CORPORATION 1999 

BRYAN ST SUITE 900 DALLAS TX 75201, DEFENDANT in the above case: 

2 

This citation is issued pursuant toa petition filed by Plaintiff on March 07, 2022, Plaintiff's attorney's | 

name and address, or Plaintiff's address if they have no attorney, are: 

Plaintiff's Address - Plaintiff's Attorney's Name: 

11494 Luna Rd Suite 200 Address: 

Dallas TX 75234 BER 

Your answer must be filed with this court, located at 100 W. WEATHERFORD ST. ROOM 450, FORT WORTH 

1X 76196 OR E-Filed by going to the followin i EL 

You "Have BEEN SUED. YOU MAY EMPLOY AN ATTORNEY TO HELP YOU IN DEFENDING AGAINST THIS LAWSUIT. BUT 

You ARE. NOT. ‘REQUIRED TO EMPLOY AN ATTORNEY. YOU OR YOUR ATTORNEY MUST FILE AN ANSWER WITH THE 

COURT. YOUR ANSWER IS DUE BY THE END OF THE 14TM DAY AFTER THE DAY YOU WERE SERVED WITH THESE 

PAPERS. IF THE 14TM DAY IS A SATURDAY, SUNDAY, OR LEGAL HOLIDAY, YOUR ANSWER iS DUE BY THE END OF THE 

- FIRST DAY FOLLOWING THE 14TM DAY THAT IS NOT A SATURDAY, SUNDAY, OR LEGAL HOLIDAY. DO NOT IGNORE 

* THESE PAPERS. IF YOU DO NOT FILE AN ANSWER BY THE DUE DATE, A DEFAULT JUDGMENT MAY BE TAKEN AGAINST 

YOU. FOR FURTHER INFORMATION, CONSULT PART V OF THE TEXAS RULES OF CIVIL PROCEDURE, WHICH IS 

AVAILABLE ONLINE AND ALSO AT THE COURT LISTED ON THIS CITATION. 

ISSUED AND SIGNED on 7th day of March, 2022. 

Signed: 3/7/2022 3:33:17 PM 

Lnendas Baddenan | 

CLERK OF THE JUSTICE COURT, PCT. ONE TARRANT 

 

COUNTY, TEXAS Re 

 

JP01-22-5C00015364

Case 4:22-cv-00305-O Document 1-3 Filed 04/13/22 Page 2 of 4 PageID 11
I received the attached Citation on 

OFFICER'S RETURN 

 

 

,20___, at 

the Citation on , 20 __.m. as detailed below: 

SERVICE COPY 

 

.m. and executed 

 

 

| further certify that | delivered to on 

 

Co ,20__, at i] __.m. a copy of this Civil Citation, 

IF GRANTED BY THE COURT: ALTERNATIVE SERVICE OF CITATION BY RULE 501.2 (E){1) 

{1} MAILING A COPY OF THE CITATION WITH A COPY OF THE PETITION ATTACHED BY FIRST CLASS MAIL 

TO THE DEFENDANT AT A SPECIFIED ADDRESS, AND ALSO LEAVING A COPY THE CITATION WITH PETITION 

ATTACHED AT THE DEFENDANT'S RESIDENCE OR OTHER PLACE WHERE THE DEFENDANT CAN PROBABLY BE 

FOUND WITH ANY PERSON FOUND THERE WHO IS AT LEAST 16 YEARS OF AGE; OR 

(2) MAILING A COPY OF THE CITATION WITH A COPY OF THE PETITION ATTACHED BY FIRST CLASS MAIL 

TO THE DEFENDANT AT A SPECIFIED ADDRESS AND ALSO BY SECURELY AFFIXING TO THE FRONT ENTRY WAY 

 

AT THE SPECIFIED ADDRESS LISTED ON THE ALTERNATIVE SERVICE REQUEST. 

ALTERNATIVE SERVICE NOTES: 

hI PACE 

 

¥ 

 

 

NON-SERVICE RETURNED TO COURT AND NOT SERVED FOR THE FOLLOWING REASONS: 

FEES: 

Service S 

Other S 

Total $ 

Eps 

 

 

CONSTABLE/SHERIFF, PRECINCT 

_ COUNTY, TEXAS 

BY: __ , Deputy 

 

COURT INFORMATION 

JUDGE RALPH SWEARINGIN, JR 

JUSTICE COURT, PRECINCT ONE 

100 W. WEATHERFORD ST. ROOM 450 

FORT WORTH, TX 76196 

PHONE NUMBER: 817-884-1395 

 

E-MAIL ADDRESS: JP1COURT@TARRANTCOUNTY.COM 

JP01-22-5C00015364 

Case 4:22-cv-00305-O Document 1-3 Filed 04/13/22 Page 3 of 4 PageID 12
 

 

fo FILED 

 

 

 

3/7/2022 8:54 AM 

vo oe Judge Ralph Swearingin 

PETITION: SMALL CLAIMS CASE Justice of the Peace, Precinct 1 JP01-22-SC00015364 | Tarrant County 

CASE NO. {court use only} MAIL TO PLTF 

in the Justice Court, Precinct ___1 Tarrant county, Texas 

ER Near Me 

PLAINTIFF 

VS. 

Aetna Health and Life Insurance Company 1399 Bryan St, Suite 900 Dallas, TX 75201 DEFENDANT(S) 

COMPLAINT: The basis for the claim which entitles the plaintiff to seek relief against the defendant is: 

ER Near Me provided medical services and was not paid a fair amount for claim #1 ERWZKFNFM00 

RELIEF: Plaintiff seeks damages In the amount of $3,825.73 , and/or return of personal property as described as follows {be 

spegific): , which has a value of 

Additionally, plaintiff seeks the following: 

1] 

plus all costs of court as allowed by law. : 

SERVICE OF CITATION: Service is requested on defendants by personal service at home or work or by alternative service as allowed 

by the Texas Justice Court Rules of Court. Other addresses where the defendant(s) may be served are: 

Aetna Health and Life Insurance Company Registered Agent: CT Corporation, 1999 Bryan St. Suite 900, Dallas, 

TX 75201 

If you wish to give your consent for the answer and any other motions or pleadings to be sent to your email address, please 

check this box, and provide your valid email address: mburk@ernearme24.com . 

I declare under penaity of perjury, pursuant to the law of the State of Texas, that all information provided is true.and correct. 

ER Near Me Is! Melody Burk 

Petitioner's Printed Name Signature of Plaintiff or Attorney 

 

 

11494 Luna Rd, Suite 200 _ 

DEFENDANT(S) INFORMATION (if known): Address of Plaintiff's Attorney, if any, or Plaintiff if none 

DATE OF BIRTH: oC 

 

. . Dallas, TX 75234 

*LAST 3 NUMBERS OF DRIVER LICENSE: = City State Zip 

“LAST 3 NUMBERS OF SOCIAL SECURITY: 

 

903-227-1875 

DEFENDANT'S PHONE NUMBER: : Phone & Fax No. of Plaintiff's Attorney, if any, or Plaintiff if none RE 

 

mburk@ernearme24.com 

Small Claim Petition. 7/2013 

 

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