Affidavit Requesting Order Form Restoring Name
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1
2IN THE
JUDICIAL DISTRICT
DISTRICT COURT OF
COUNTY, KANSAS
IN THE MATTER OF THE MARRIAGE OF
, Petitioner,
Case No.
and
, Respondent.
AFFIDAVIT REQUESTING ORDER RESTORING NAME
moves the Court to restore:
“
My maiden name of
.
“
My previous married name of
.
VERIFICATION
I verify under penalty of perjury under the laws of the state of Kansas that the foregoing
is true and correct. Executed on ______________, 20___.
__________________________________________
Signature
Name Print):__________________________________
Address (1):___________________________________
Address (2):___________________________________
City, ST, Zip:__________________________________
Telephone:____________________________________
Authority: K.S.A. 23-2716.
KSJC 8/2012
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