WPC  ҥX6X{IIJ*Z(-q𹁆 qg*枉@2~$8QbFZv"y_/nUx͊gj&টn4g|xJCXHdW$IfdpOf[F1;Ez+2C=z #oqms$e k7XRD6T3z~(K)?JG3vbv9& †^^EuK |ٵ!mf2v POi U15/%o'0 ?&zɔЈ .@4FűȖ){ER^oύ xd5qhSq#UN % 0:UNU>i^ w4 mHP LaserJet 4000 Series PCL6V,,,,V0(9 Z6Times New Roman RegularX($USUS.,(hH  Z6Times New Roman Regular\  `&Times New Roman e 4 Do4DMIN03|xU !USUS.,  _  X.XXXO=(#(Revised7/05)#X`XXX.k#X.XXX`Ԉ     `     h      p   FileStampDate     `     h      p   CaseNumber______ { Preparedby: S Filersname,SC# ? Filersaddress + Filersphonenumber  t {Filersfaxphonenumber}  ` {Filersemailaddress}  L  AttorneyforPlaintiff  8  @*@e e InTheDistrictCourtof______County,Kansas   @*Plaintiffsname   Plaintiff c    `     h   vs.   `     h     CaseNo.______ ; Defendantsname   Defendant p Defendantsaddress \ PursuanttoChapter61of 4 KansasStatutesAnnotated   #X`XXX.#X.XXX`ServiceBy:CertifiedMail    PETITION _ (worthlesscheck) K Y  Theplaintiffstatesthefollowingclaim(s): !l!   1.Thatthedefendant(s)gaveoneormoreworthlesschecksasdefinedbylaw. !X"   2.Thatplaintiffistheholderofsaidcheck(s)andhasmadeproperwrittendemandupon #0!$ defendantforpaymentasrequiredbylawpursuanttoK.S.A.602610.Morethanfourteen(14)days $"% havepassedthereafterwithoutpaymentbythedefendant(s). %#&   3.ThatpursuanttoK.S.A.602610,plaintiffisentitledtojudgmentagainstthedefendant(s) '$( fortheamountofthecheck(s)intheamountof$______,interestbeforejudgmentintheamountof o(%) $______#X`XXX.#X.XXX`,theincurredservicechargeintheamountof$______#X`XXX. #X.XXX`,thecostsofrestrictedmailinthe [)&* amountof$______#X`XXX.P #X.XXX`,statutorydamagesintheamountof$______#X`XXX. #X.XXX`,andreasonableattorneyfeesin G*'+ theamountof$______#X`XXX.K #X.XXX`Ԁandanyadditionalattorneyfeesorderedbythecourt. 3+(, #X`XXX. #X.XXX`  4.Thatdefendant(s)may,priortothecommencementofa_dispositional_ԀhearingbytheCourt,  -h*. tendertoplaintiffassatisfactionoftheclaimanamountofmoneyequalto$______#X`XXX.h #X.XXX`Ԁwhichamount -T+/ isequaltothesumoftheamountofthecheck(s),theincurredcourtcosts,servicecharge,costsof .@,0 restrictedmailandthecostsofcollection,includingbutnotlimitedtoreasonableattorneyfees. /,-1 O e     WHEREFORE,plaintiffdemandsjudgmentagainstthedefendant(s)for: Q Faceamountofcheck(s)0  $______#X`XXX. #X.XXX`,)(#(# Servicecharge0 0 (# (#$______#X`XXX.#X.XXX`,(#(# Restrictedmailcosts0 0 (# (#$______#X`XXX.c#X.XXX`, (#(# Statutorydamages0 0 (# (#$______,#X`XXX.#X.XXX` (#(# #X`XXX.#X.XXX`Attorneyfees0 ` 0 ` (#` (#0 (# (#$______#X`XXX.#X.XXX`, t(#(# Interestbeforejudgment0  $______,#X`XXX.#X.XXX` `(#(#    `     h foratotalof `    $______,#X`XXX.#X.XXX`  8  plusinterestafterjudgment0  ______%peryear,#X`XXX.#X.XXX`u (#(# andcourtcosts. a     `     h   #X`XXX.#X.XXX`_________________________________ 9     `     h   PlaintifforPlaintiffAttorneySignature %    `     h   SC#  {Ifapplicable,includethefollowing:  Thisisacommunicationfromadebtcollector.Thisisanattempttocollectadebtandany \ informationobtainedwillbeusedforthatpurpose.} H #X`XXX.X#