WPC W*yPߠӠҼ,a3Ze67Ӭ9yQ2ׯmh'r=F_Wl $kc𕙢Q6q|"F6b̄cn6 ӈ~ŻTqd1mg؉/v݃.V`{y"~"z@ۦ h(#h(#   Plaintiff, 0   h )$ t (#(# v   `    0 h )     p   CaseNo._________ Z h(#h(#    `  ,0  0h(#(#) @ h(#h(#   Defendant.   0 h )& h(#h(# ProceedingPursuanttoK.S.A.Chapter61       DEFENDANT'SCLAIM t  8Instructions: @   1.Asstatedinthesummons,ifyouhaveaclaimagainsttheplaintiffwhicharises ^ outofthetransactionoroccurrencewhichisthesubjectofplaintiff'sclaimandyourclaim D doesnotexceed$4,000,youmuststateyourclaiminthespaceprovidedbelow.Ifyour * claimagainsttheplaintiffexceeds$4.000,youmaystateyourclaiminthespaceprovided  below.Indeterminingwhetherornotyourclaimagainsttheplaintiffexceeds$4,000,do  notincludeinterest,costsandanydamagesunderK.S.A.60-2610andamendments  thereto,butdoincludethevalueofanypersonalpropertysoughttoberecoveredas r determinedbyyourestimateofitsvalueunderoath. X   2.Beclearandconciseinstatingyourclaim. $t   3.Ifthevalueofyourclaimexceeds$4,000(notincludinginterest,costsandany @ damagesawardedunderK.S.A.60-2610andamendmentsthereto,butincludingthevalue  &  ofanypersonalpropertysoughttoberecovered,asdeterminedbyyourestimateofits ! ! valueunderoath),thecourtmustdecidewhetheryoumaypursueyourentireclaimoronly "" thatportionnotexceeding$4,000. ##   4.Ifyourclaimexceeds$4,000andthecourtdeterminesthatyoumaynotpursue T% % theentireclaimatthehearing,youhavethreealternatives:(1)Makenodemandfor :&!& judgmentandreservetherighttopursueyourentireclaiminacourtofcompetent  'p"' jurisdiction;(2)makedemandforjudgmentofthatportionofyourclaimwhichdoesnot (V#( exceed$4,000andreservetherighttobringanactioninacourtofcompetentjurisdiction (<$) foranyamountinexcessthereof;or(3)makedemandforjudgmentofthatportionofyour )"%* claimwhichdoesnotexceed$4,000andwaiveyourrighttorecoveranyexcess. *&+   5.Whencompleted,thisformmustbefiledwiththejudgeortheclerkofthecourt ,'- onorbeforethetimestatedinthesummonsforthetrial. j-(. _ԇ    Statementofclaim: ~ (#(#K(#(#(#K(#(#(#K(#  I, `     h ,havingreadtheinstructionsabove,assertthefollowing  4 claimagainst    h   ,plaintiff:    (#(#K(#(#(#K(#(#(#K(#  Demandforjudgment: H    Basedontheclaimstatedabove,judgmentisdemandedagainstplaintiffasfollows: f   1.Paymentof$   h ,plusinterest,costsandanydamagesawardedunder 2 K.S.A.60-2610andamendmentsthereto.    2.Recoveryofthefollowingdescribedpersonalproperty,pluscosts:(#(#K(#  (#(#K(#Thispropertyhasanestimatedvalueof$   p   . F   I, `    ,herebyswearthat,tothebestofmyknowledgeandbelief,the b aboveclaimassertedagainsttheplaintiff(includingtheestimateofvalueofanyproperty H soughttoberecovered)isajustandtruestatement. .   0 ` 0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(# p      x   (#(#   0 ` 0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#DefendantsSignaturev! (#(#   Subscribedandsworntobeforemeonthe p dayof   x ,2 . B#"   0 ` 0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(# p   __   x   (#(#   0 ` 0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#Judge(clerkornotary)&*"&(#(# #X/XXX5#