WPC  
      B     7eXe+KEqp_V$jVRkHō3vOtv:E*_=qez+W58K{9hI7;uPC~Hz酀uMe!itH(ӊN`vfW编a?HJب"&")z#4,wmsO9ZO# HF%vRF4{@)8JcQxķ͹~ؼ.ËdYqcD_^"N,ZU;D7ecOV>5YĈ,.sIiIYckV{W-vvZm>vThTt,坆h e{%BKc.JejѲctij(2tRd0!V0i}}ces~ׯ'.?50 *           #     L   U   N     	%      c  0   :   i   U   >     	1   u     	7   2   V  0   d    0   2  	  0   U     0   U   s   U   >                9     	         	         0   c   0   	         	         	         	         	         	        ^        w        4                      *  	m      ,  N      C   b      E            E            E            E            E            E            E            E            E            E  0%      M   H P L J 3 3 0 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              0                                                                                                                                                                 ( 9  	   Z  6 T i m e s   N e w   R o m a n   R e g u l a r           X    (                  $          USUS. ,   \	  	   `  & T i m e s   N e w   R o m a n                          3#   3 7 = C I Q Y a g       1 .   a .   i .   ( 1 )   ( a )   ( i )   1 )   a )                i )                                           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     (   -               2$       
   !    USUS. ,          (   -               2$       
   !    USUS. ,       \	  	   `   & T i m e s   N e w   R o m a n          
      
 
  '    USUS. ,      _                 `	               h               p                x 8/1/07 
   /  
   )    USUS. ,      _         	   $      (#   X$    X  X  X X         	  =              '    (#   (#'    1   X X #   X  X  1   #  T e x t 1    T e x t 2       (       ;           3$       2  #      0
   
 .3
   
 0      T e x t 3    T e x t 4    T e x t 5    T e x t 6    C h e c k 1    C h e c k 2   |6Z         DM6    :i +003| x                    U    -  -       H   $           $   4 B o d y   T e x t   B o d y   T e x t                                   
   !    USUS. ,      _                         8    X  X       d                  d  8 @    VV)  173   	          X  X  X X            X    ,                     INTHEDISTRICTCOURTOF     %     -     ________________-     %    b   ԀCOUNTY,KANSAS   	          3   	    p    x   (#   X3    33     INTHEINTERESTOF:   	    Ѐ   	       _  .  0      p" (#    pX0 Name%     -     ____________________________________-     %           p CaseNo.%     -     ____________________-     %    )      	  
      .  _   <   	    z    x   (#   p" (#<       33  DOB%     -     xx#   X  X  X X   # %          X  X  X X /xx#   X  X  X XL  #    X  X  X X /____%     %       %     -     %       0     A#   X  X  X X  #    X  X  X X &#   X  X  X X5  #    X  X  X X %     %       Ԁmale%     #   X  X  X X{  #    X  X  X X Ԁ#   X  X  X X  #    X  X  X X &#   X  X  X X1  # %          X  X  X X Ԁfemale#   X  X  X X  #    X  X  X X      (#(#     _  .   <        z p" (#    z X<    33     #   X  X  X X  #            33  APPLICATIONFORSECUREPLACEMENT   	 "		   PursuanttoK.S.A.382260   	 	
             Comesnow(Nameandtitleofapplicant)󀀀andrequestsanorderauthorizingplacement   	    ofthechildnamedaboveinasecurefacility.Insupportthereofthefollowingisalleged:   	    1.0     ThisCourtissuedavalidcourtordertoremaininplacementon___________________   	    anditisfiledinthecaptionedmatter;     (#(#  2.0     Thechildnamedaboveandtheguardianadlitemappointedhereinwerepresentand   	 l   informedorallyoftheorderandtheconsequencesofaviolationoftheordertoremainin   	 rX   placement;Copiesoftheorderwereprovidedtothechildandguardianadlitem;    ^D (#(#  2.0     Thechildnamedabovewasadjudicatedhereinon__(date)___________pursuantto   	 J0   subsection&(d)(6)&(d)(7)&(d)(8)&(d)(9)&(d)(10)&(d)(12)ofK.S.A.382202;    6 (#(#  3.0     Thechildnamedabovehasviolatedtheordertoremaininplacement,withoutgood   	 &   cause,asfollows:________________________________________________________   	    _______________________________________________________________________.     (#(#       Whereupontheapplicantrequestsahearingand&thatthechildnamedabovebe   	    detainedpendinghearing&thattheCourtauthorizeplacementofthechildnamedabove   	    inasecurefacility.   	         0     0    (#(# 0    z(#(# 0    pz(#z(#     ""J "_  pp2  0 @  "z(#z(# 0 @  "p(#p(# 0 @  "p(#p(# 0 @  "p(#p(# Applicant    R#8! p(#p(#     X  X  X X @    $  VERIFICATION   	 '"%   @    *  STATEOFKANSAS0    z )    ($' z(#z(#                 0    z )ss:    )%( z(#z(#   )      X  X  X X                      )          COUNTYOF__________0    z ) )       ݌    *&) z(#z(#  Ќ                  X  X  X X 	     %   X  X  XX  X X%  )      X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X                                )           )       ݌̌                  X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X 	      )      X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X                                )  k             COMESNOW____________________,oflawfulage,beingfirstdulyswornandunder   	 v-\),   
    
 oath,andstates: )  k     ݌   	 b.H*-   Ќ                  X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X 	          Iamtheapplicantabovenamed,andIhavereadandunderstandtheaboveandforegoing,   	       
    
 andbelievethatallofthecontentthereofistrueandcorrect.   	                        z     p                    z 0    p     ""J "_  pp2   @  "  @  "  @  " Applicant     p(#p(#   )      X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X                                )  a             0     0    (#(# 0    z(#(#  )  a     ݌    z(#z(#  Ќ                  X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X 	      )      X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X                                )  T         )  T     ݌̌                  X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X 	      )      X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X                                )               Subscribedandsworntobeforemethis_____dayof_______________,_______. )    4    ݌   	 z`   Ќ                  X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X 	      )      X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X                                )  !         )  !  >#   ݌̌                  X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X 	      )      X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X                                )  $         )  $  %   ݌̌                  X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X 	      )      X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X                                )  5'                           z     p ___________________________ )  5'  x(   ݌   	 >$
   Ќ                  X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X 	      )      X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X                                )  =*                           z     p NotaryPublic/ClerkoftheCourt )  =*  +   ݌   	 *   Ќ                    	          )                                )  k,        #   X  X  X X  # Authority )  k,  ,   ݌   	    Ќ                   	        _,        K.S.A.382260.   	    @    $  NotesonUse   	         Anypersonmayfiletheverifiedapplicationrequestingauthorizationforsecureplacement   	 p   ofachildadjudicatedpursuanttoK.S.A.382202(d)(6),(d)(7),(d)(8),(d)(9),(d)(10)or(d)(12),if   	 v\   anordertoremaininplacement(Form172)hasbeencorrectlyissued.Theapplicationmustbe   	 bH   verified,andincludethespecificfactssupportingtherequest.Acopyoftheapplicationshallbe   	 N4   providedtothechildattheprobablecausehearingwhichshallbeheldwithin24hours,notincluding   	 :    Saturdays,Sundaysorlegalholidays,oftheexecutionofanexparteorderforsecureplacement.   	 &      X  X  X X )   X  X  XX  X X  ) %   X  X  XX  X X%  )      X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X    X  X  X X                     )  )1         )  )1  Z2   ݌̌                    	     #   X  X  X X0  # 
