Date: 8/10/2015 Crawford County District Court (Pittsburg) NO.

0367144
Time: 01 :07 PM Receipt Page 1 of 1

$
Received of: Day, Noah Ian (plaintiff) ---- 67.50

Sixty-Seven and 50/100 Dollars

Case: 2015-SC-000071-P Plaintiff: Noah Ian Day vs. Lori Fleming Amount

Small Claims Docket Fee ($500.01 - $4,000) 67.50

Total: 67.50

Payment Method: Cash

Amount Tendered: 67.50
By:
Clerk / Deputy Clerk
 Form KS41

DISTRICT COURT OF _~~(,--d---=::lA.=\-,-!-=O---,-{--!::J:...;... _

COUNTY, KANSAS

PETITION
Small Claims Procedure

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Plaintiff name and address

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vs.
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Defendant
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name and address

To Plaintiff: Read instructions on bottom of this form. Set forth a No. I~Se, ?/ I
short and plain statement of your claim below. Pursuant to Ch. 61 oj K.SA.

Plaintiff, having read the instructions on the bottom of the petition, asserts the following claim against the above defendant:

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Ba:.::1on the claim stated above, judgment is demanded against defendant as follows:
~ Payment of $ LJ, £:> Co U ,plus interest, costs and any damages awarded under K.S.A. §60-2610.
o Recovery of tbe following described personal property. plus costs-estimated value of property $ _

The plaintiff hereby declares under penalty of perjury under the laws of the State of Kansas that, to the best of plaintiff's knowledge
and belief, the above claim asserted against the defendant (including the estimate of value of any property sought to be recovered)
is a just, true, and COlTect statement, exclusive of any valid claim or defense which defe idant may have.
o Check this box if the plaintiff is an attorney or a corporation or entity that trappe'
or person qualified to be an attorney as defined by law.
Executed on 12- ,I 6 -) '5

o Indicate
) ourself.
this box to request personal or residence service of the summons and not return receipt service.
Follow strict terms of the return forms if you make the serv ice) ourself.
You may make return receipt WI ice

-------------------------------~=-----~~----~-----------
The trial on this matter is set for hAi?t1.~ .-:?~
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This communication is an attempt to collect a debt and any information obtained will be used for that purpose.

INSTRUCTIONS TO PLAI;\ITlFF:
I. State the claim you have against the defendant in the space provided on the petition form. Be clear and concise.
2. Your total claim against defendant may not exceed $4.000. not including interest, costs and any damages awarded under
K.S.A. §60-261O. If you are seeking the recovery of personal property, the value of that property shall be based on your estimate
of its value under unsworn declaration under penalty of perjury.
3. You must be present in person at the hearing in order to avoid default judgment against you on any claim defendant may have
which arises out of the transaction or occurrence which is the subject of your claim against the uetenduut.
4. You must make demand for judgment in one or both of the spaces provided on the petition form.
S. Except as provided by law. neither you nor the defendant are permitted to appear with an attorney at the hearing unless the other
party is an attorney or is a corporation or entity that uses an attorney in a representative capacity. In such case you are entitled to one
continuance to obtain an attorney.
6. You may not file more than twenty small claims under the small claims procedure act ill this court during any calendar year.
7. After completing the petition form , you must sign it. Your signature is under unsworn declaration under penalty of perjury.