WPC  
      K     9$SxYmm)x?KQ5]oYq`KbWxM=̋,9G&-B>ȹ;=g!)EX)6Xq׈sE2'NT/iسYeN.v$1A0hjO.C#ah]-ێ[iC+-U*S>LYpŚp[4"úJ139Ck
JT,&a*;Q·Iq"1'|7Pia1Hd|ֽix-
x3Cj2W9:g%4mu88Y~+hs%FEyIw ͖yy[t1	/e:(#|4;qi"wid֥bbXۯq:>1E{zMA8JWQc]ժW3D~Lo .           #        U   N   M  	%        0   :     0   d    0   2  ?	   U
   >   q
  N      
  0   U   
          0   U      	      R   	      b   U   >   r   	         	         	         	         	         b        ^        w        4              0        ?  	m      A  	1   {   X  	7   2     	1   u     	7   2   z  0   c        t        n     0                                                        0.        	B      V            V  	D   1   s  	D   +                 	D   /      H P L J 3 3 0 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              0                                                                                                                                                                 ( 9  	   Z  6 T i m e s   N e w   R o m a n   R e g u l a r           X    (                  $          USUS. ,      0                . H e a d e r           (#     X      XX S            \	  	   `   & T i m e s   N e w   R o m a n         S  A  7        X   `	   h   p    x   (#A S            \	  	   `   & T i m e s   N e w   R o m a n         S     X      XX     0   m             . F o o t e r           (# S            \	  	   `   & T i m e s   N e w   R o m a n         S  A  7        X   `	   h   p    x   (#A S            \	  	   `   & T i m e s   N e w   R o m a n         S  \	  	   `   & T i m e s   N e w   R o m a n               (   -               2$       
   !    USUS. ,       
      
   )    USUS. ,      _            $      (#   X$    X4  X  X X           =              '    (#   (#'     (   -               2$       
   !    USUS. ,       T e x t 1    T e x t 2    \	  	   `   & T i m e s   N e w   R o m a n          T e x t 4    T e x t 5    T e x t 6    C h e c k 1    C h e c k 2   -  -   a|6Z         DM6    :i +003| x                    U                   8j        3 C I O U [ a g m    N u m b e r s   1 .   1 .   1 .   1 .   1 .   1 .   1 .   1 .                 1 .                                                        3#   3 7 = C I Q Y a g       1 .   a .   i .   ( 1 )   ( a )   ( i )   1 )   a )                i )                                           (       ;           3$       2  #      0
   
 .3
   
 0      
   j   
 	  '    USUS. ,      _           "   X     ""I "  
   d   
 	  '    USUS. ,      _             8/1/07   	           H   :          *   4 H e a d i n g   4   H e a d i n g   4                  
                              H   2           2   4 B o d y   T e x t   B o d y   T e x t       X      XX                                                    d   ( ( )     1                        d x    d  '                              d x    d ( )     2                        d x    d
   !    USUS. ,      _                      !        @    VV)  124   	 {              ,  
                    8   4 X  X       d                  d  8 =    4  X   X       d                 d=      !       X4  X  X X   INTHEDISTRICTCOURTOF     %     -     ________________-     %       ԀCOUNTY,KANSAS   	 g         3   	    p    x   (#   X3    33     INTHEINTERESTOF:   	 +      _  .  0      p" (#    pX0 Name%     -     ________________________________-     %           p CaseNo.___________________   	 a
      .  _   <   	    z    x   (#   p" (#<       33  DOB%     -     xx/xx/____%       %     %    (   %     -     %    F   0     A#   X4  X  X X4v  #    X4  X  X X4 &#   X4  X  X X4  #    X4  X  X X4 %     %    	   Ԁmale%     #   X4  X  X X4  #    X4  X  X X4 Ԁ#   X4  X  X X4\  #    X4  X  X X4 &#   X4  X  X X4  # %    ,      X4  X  X X4 Ԁfemale    | (#(#     _  .   <        z p" (#    z X<    33     #   X4  X  X X4  # @     
 
  APPLICATIONFORDISCLOSUREOFINFORMATION   	 		   @    ''  PursuanttoK.S.A.382229(a)   	 #

      X4  X  X X4 STATEOFKANSAS0    z )    t z(#z(#                     z )ss:0    p     
 p(#p(#   '      X4  X  X X4            33        '  "        COUNTYOF__________) '  "  z   ݌   	 %   Ќ        33        X4  X  X X4 	     #   X4  X  X X4d  #      Theundersignedapplicantbeingfirstdulyswornallegesandstatesasfollows:   	     
                   ( j        9                                3                                                "   3                   "        39
   2  j      1
   
 .3
   
 0          Theapplicantis_________________________.   39
  f
   ݌    3 (#(#  Ќ	     "   3                  "        3-   2  j      2
   
 .3
   
 0             X4  X  X X4 Thechild(ren)namedaboveisthesubjectofareportofabuseorneglect.   3-  Z   ݌    N (#(#  Ќ	     "   3                  "        3_   2  j      3
   
 .3
   
 0          #   X4  X  X X4  # Thefollowingdocuments,reportsand/orinformationarerequested:(Listspecifically.)   	 i   _______________________________________________________________________   	 	   _______________________________________________________________________   	 $   _______________________________________________________________________   3_     ݌    ? (#(#  Ќ	     "   3                  "        3   2  j      4
   
 .3
   
 0          Thereasonsfortherequestare:_____________________________________________   	 u   _______________________________________________________________________   	 !   _______________________________________________________________________   3     ݌    &" (#(#  Ќ	          Furtherapplicantsaithnot.   	 \$                      z     p __________________________   	 &"                       z     p Applicant   	 '2#!      X4  X  X X4 @    $  VERIFICATION   	 )h%#    '      X4  X  X X4    X4  X  X X4            33                  '           '    {   ݌̌        33        X4  X  X X4    X4  X  X X4 	           33  STATEOFKANSAS0    z )    +o'% z(#z(#                     z )ss:0    p     ,[(& p(#p(#   '      X4  X  X X4                      '          COUNTYOF__________) '    #   ݌   	 -G)'   Ќ                  X4  X  X X4 	     #   X4  X  X X4  #    X4  X  X X4    	 /+)   #   X4  X  X X4  #    X4  X  X X4 %   X4  X  XX  X X4%  '      X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4                                '           '       ݌̌                  X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4 	      '      X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4                      '  (             COMESNOW____________________,oflawfulage,beingfirstdulyswornandunder   	 {    oath,andstates: '  (  Y   ݌   	 S   Ќ                  X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4 	      '      X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4                      '  H             Iamtheapplicantabovenamed,andIhavereadandunderstandtheaboveandforegoing   	 +   ApplicationforDisclosureofInformation,andbelievethatallofthecontentthereofistrueand   	 
t   correct. '  H  y   ݌   	 L	   Ќ                  X4  X  X X4    X4  X  X X4 	     )   X4  X  XX  X X4f  )  '      X4  X  X X4                                '  M                           z     p     ""J "_  pp2                     z     p Applicant '  M     ݌   	    Ќ                  X4  X  X X4 	     %   X4  X  XX  X X4%  '      X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4                                '                0     0    (#(# 0    z(#(#  '     Q!   ݌    z(#z(#  Ќ                  X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4 	      '      X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4                                '  #         '  #  D$   ݌̌                  X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4 	      '      X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4                                '  %             Subscribedandsworntobeforemethis_____dayof_______________,_______. '  %  &   ݌   	 O   Ќ                  X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4 	      '      X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4                                '  (         '  (  )   ݌̌                  X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4 	      '      X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4                                '  E+         '  E+  ,   ݌̌                  X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4 	      '      X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4                                '  -                           z     p     ""J "_  pp2                     z     p     ""J "_  pp2                     z     p NotaryPublic/ClerkoftheCourt/Deputy '  -  %/   ݌   	 \   Ќ                  X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4 	      '      X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4    X4  X  X X4                      '  1        #   X4  X  X X4G  #  '  1  2   ݌̌                  X4  X  X X4 	     )   X4  X  XX  X X4  )      '      X4  X  X X4                         '  3        Authority '  3  4   ݌   	     Ќ                 X4  X  X X4 	        3   %   X4  X  XX  X X4% K.S.A.382229.   	    @    $  NotesonUse   	 _             Thesecretary,alawenforcementofficer,oramultidisciplinaryteammayrequestdisclosure   	 7   ofdocuments,reportsorinformationinregardtoachildbyfilingthisformwiththecourt.Thecourt   	 #    mayissueasubpoena(Form125),subpoenaducestecumoranorderfortheproductionofthe   	 !    requesteddocuments,reportsorinformationuponafindingthatthereisprobablecausetobelieve   	 !l!   thattheinformationsoughtwillassistintheinvestigationofareportofchildabuseorneglect.The   	 "X"   respondingpersonoragencyshallhaveatleast5days,excludingSaturdays,Sundaysandholidays,   	 #D #   todeliverthatwhichissought.Thecourtshallretainallapplicationsandcopiesofsubpoenaor   	 $0!$   ordersissuedunderthisprocedureinafilespecificallyforthatpurpose.Thestatuteprovidesa   	 %"%   mechanismforrequestingthatthesubpoenaororderbequashed.   	 &#&   )   X4  X  XX  X X44  ) %   X4  X  XX  X X4% 
