WPC $4CX16umXQI\p#x p@dRP<0A=aw Sk>^*uP4XK< DJ g\J`i~  Ŭ؁yāOSVYU[ W'Ұ=}TuKI[àC/H]Dɦ1y T/AWPe怤NBr]ӊb!qp RǺM@Nul`vFq`jxg"_}<*Ќ̜!~w!%`aԁǘs?T9 5c/H:E_&z&AgsqԁwS7b 0O- r;tɪȽrLK^ "m8e-^)\rSbe ԋ\gV.bF-bS-~oޤC0RGX #!UN % 0(U:E^ w@4 mHP LaserJet 4000 Series PCL6V,,,,V0(@ Z6Times New Roman RegularX($,ZAZ"Arial Regularp2 ESESDSESUva2yFiles3|xU !  _    XX  @ @:(#K.S.A.612713(c)  @6(#SmallClaimsDefendantsClaim#X^XC# ` #XdXXX^#XXd(7/1/05)#XdXn#X^XXXd ` 7 INTHE򀀀JUDICIALDISTRICT  ЀDISTRICTCOURTOF򀀀COUNTY,KANSAS       `  ,0  0h(#(#)> 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 s  Instructions: ?   1.Asstatedinthesummons,ifyouhaveaclaimagainsttheplaintiffwhicharisesoutofthetransactionoroccurrencewhichisthesubjectofplaintiff'sclaimandyourclaimdoesnotexceed$4,000,youmuststateyourclaiminthespaceprovidedbelow.Ifyourclaimagainsttheplaintiffexceeds$4.000,youmaystateyourclaiminthespaceprovidedbelow.Indeterminingwhetherornotyourclaimagainsttheplaintiffexceeds$4,000,donotincludeinterest,costsandanydamagesunderK.S.A.60-2610andamendmentsthereto,butdoincludethevalueofanypersonalpropertysoughttoberecoveredasdeterminedbyyourestimateofitsvalueunderoath.  2.Beclearandconciseinstatingyourclaim.  3.Ifthevalueofyourclaimexceeds$4,000(notincludinginterest,costsandanydamagesawardedunderK.S.A.60-2610andamendmentsthereto,butincludingthevalueofanypersonalpropertysoughttoberecovered,asdeterminedbyyourestimateofitsvalueunderoath),thecourtmustdecidewhetheryoumaypursueyourentireclaimoronlythatportionnotexceeding$4,000.  4.Ifyourclaimexceeds$4,000andthecourtdeterminesthatyoumaynotpursuetheentireclaimatthehearing,youhavethreealternatives:(1)Makenodemandforjudgmentandreservetherighttopursueyourentireclaiminacourtofcompetentjurisdiction;(2)makedemandforjudgmentofthatportionofyourclaimwhichdoesnotexceed$4,000andreservetherighttobringanactioninacourtofcompetentjurisdictionforanyamountinexcessthereof;or(3)makedemandforjudgmentofthatportionofyourclaimwhichdoesnotexceed$4,000andwaiveyourrighttorecoveranyexcess.  5.Whencompleted,thisformmustbefiledwiththejudgeortheclerkofthecourtonorbeforethetimestatedinthesummonsforthetrial. f-(. Ї    Statementofclaim: { (#(#K(#(#(#K(#(#(#K(#  I, `     h ,havingreadtheinstructionsabove,assertthefollowing  . claimagainst    h   ,plaintiff:     (#(#K(#   (#(#K(# `     h      p      x    (#(#K(# `     h      p      x    Demandforjudgment: B    Basedontheclaimstatedabove,judgmentisdemandedagainstplaintiffasfollows:  1.Paymentof$   h ,plusinterest,costsandanydamagesawardedunder ) K.S.A.60-2610andamendmentsthereto.  2.Recoveryofthefollowingdescribedpersonalproperty,pluscosts: (#(#K(#    (#(#K(# `     h      p      x  Thispropertyhasanestimatedvalueof$   p   . =   I, `    ,herebyswearthat,tothebestofmyknowledgeandbelief,the  Y aboveclaimassertedagainsttheplaintiff(includingtheestimateofvalueofanypropertysoughttoberecovered)isajustandtruestatement.  0 ` 0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(# p   (Signature) x   @  (#(#   0 ` 0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#Defendant p(#p(#   Subscribedandsworntobeforemeonthe p dayof   x ,2 . 8#"   0 ` 0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(# p   (Signature) x   @ %:!%(#(#   0 ` 0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#0p(#(#Judge(clerkornotary) p(#p(# #XXXX6c#