Form Ps-3936 - Petition (Small Claims Procedure) printable pdf download

IN THE EIGHTEENTH JUDICIAL DISTRICT

DISTRICT COURT, SEDGWICK COUNTY, KANSAS

CIVIL DEPARTMENT

______

________________________________________________________________________

(Print Name)

Plaintiff(s)

_______________________________________________________________________________

(Address)

(Phone Number)

_______________________________________________________________________________

(City)

(State)

(Zip Code)

CASE NO. ___

_______________________________________________________________________________

___________________________________________

(Print Name)

Defendant(s)

_______________________________________________________________________________

(Address)

(Phone Number)

_______________________________________________________________________________

(City)

(State)

(Zip Code)

PETITION

(Small Claims Procedure)

PURSUANT TO CHAPTER 61 OF

KANSAS STATUTES ANNOTATED

INSTRUCTIONS TO PLAINTIFF:

1. State the claim you have against the defendant(s) in the space provided. Be clear and concise.

2. Your total claim against the defendant(s) may not exceed $4,000, not including interest, costs, and damages awarded under K.S.A. 60-2610 and amendments thereto. If you are

seeking the recovery of personal property, the value of that property shall be based on your estimate of its value under oath.

3. You must be present in person at the hearing in order to avoid default judgment against you on any claim defendant(s) may have which arises out of the transaction or occurrence

which is the subject to your claim against the defendant(s).

4. You must make demand for judgment in one or both of the spaces provided below.

5. Except as provided by law, neither you nor the defendant(s) is permitted to appear with an attorney at the hearing.

6. You may not file more than twenty (20) small claims under the small claims procedure act in this court during any calendar year.

7. After completing this form, you must subscribe to the following oath.

STATEMENT OF CLAIM:

Plaintiff, having read the instructions above, asserts the following claim against the above defendant(s): ____________________________________________________________

___________________________________________________________________________________________________________________________________________________

DEMAND FOR JUDGMENT:

Based on the claim stated above, judgment is demanded against defendant(s) as follows:

1. Payment of $ ______________________ , plus interest, costs and any damages awarded under K.S.A. 60-2610 and amendments thereto.

2. Recovery of the following described personal property, plus costs: ______________________________________________________________________________________

_____________________________________________________________________________________ This property has an estimated value of $ ___________________________.

I, _____________________________________________________ hereby swear that, to the best of my knowledge and belief, the foregoing claim asserted against the defendant

(including the estimate of value of any property sought to be recovered) is a just and true statement, exclusive of any valid claim or defense which defendant may have.

_______________________________________________________________________

Plaintiff’s Signature

Subscribed and sworn to before me on the __________ day of ____________________________________ , 20 _________ .

_______________________________________________________________________

Judge (Deputy Clerk or Notary)

Indicate this box to request conventional sheriff or process server service of the summons and not certified mail

service.

If you do not mark this box the sheriff may make certified mail service or you may make certified mail service. Follow strict terms of the "returns" on the summons forms if you

make the service yourself.

REASONABLE ACCOMMODATIONS WILL BE PROVIDED IN ACCORDANCE WITH THE AMERICANS WITH DISABILITIES ACT.

Small Claims Packet - Petition

Rev 09/2014

PS-3936 Page 1 of 3