Kansas > Statewide > District Court > Chapter 61 > Pleadings
Petition (Worthless Check) - Kansas
| Petition (Worthless Check) Form. This is a Kansas form and can be used in Pleadings Chapter 61 District Court Statewide . |
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File Stamp Date Case Number ______Prepared by: Filer=s name, SC# Filer=s address Filer=s phone number {Filer=s fax phone number} {Filer=s e-mail address} Attorney for Plaintiff In The District Court of ______ County, Kansas Plaintiff=s name Plaintiff vs. Case No. ______ Defendant=s name Defendant Defendant=s address {Defendant=s SSN/TIN} Pursuant to Chapter 61 of Kansas Statutes Annotated Service By: Certified Mail PETITION (worthless check) The plaintiff states the following claim(s): 1. That the defendant(s) gave one or more worthless checks as defined by law. 2. That plaintiff is the holder of said check(s) and has made proper written demand upondefendant for payment as required by law pursuant to K.S.A. 60-2610. More than fourteen (14)days have passed thereafter without payment by the defendant(s). 3. That pursuant to K.S.A. 60-2610, plaintiff is entitled to judgment against thedefendant(s) for the amount of the check(s) in the amount of $______, interest before judgment inthe amount of $______, the incurred service charge in the amount of $______, the costs ofrestricted mail in the amount of $______, statutory damages in the amount of $______, andreasonable attorney fees in the amount of $______ and any additional attorney fees ordered by the<<<<<<<<<********>>>>>>>>>>>>> 2court. 4. That defendant(s) may, prior to the commencement of a dispositional hearing by theCourt, tender to plaintiff as satisfaction of the claim an amount of money equal to $______ whichamount is equal to the sum of the amount of the check(s), the incurred court costs, servicecharge, costs of restricted mail and the costs of collection, including but not limited to reasonableattorney fees. WHEREFORE, plaintiff demands judgment against the defendant(s) for:Face amount of check(s) $ ______, Service charge $ ______, Restricted mail costs $ ______, Statutory damages $ ______, Attorney fees $ ______, Interest before judgment $ ______, for a total of $ ______, plus interest after judgment ______ % per year, and court costs. _________________________________ Plaintiff or Plaintiff Attorney Signature SC#If applicable, include the following: This is a communication from a debt collector. This is an attempt to collect a debt and anyinformation obtained will be used for that purpose.
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