7/2018 KSJC 1 Your name: Case Number Confidential Information for Order Transferring Wireless Telephone Number(s) CONFIDENTIAL DO NOT FILE THIS FORM WITH THE COURT. DO NO T PLACE IN THE COURT FILE. ATTENTION PROTECTED PERSON: This form should not be filed with the court. Complete this form and send it to the wireless service provider (service provider), along with a copy of the Order Transferring Wireless Telephone Number(s). To be completed by Protected Person: The service provider is (name of company): The current account holder is (name of defendant): The new account holder is (your name): Your contact information: (This information will be used by the service provider only. The service provider will use this information to contact you to set up your account.) 1) The best phone number to reach you is (list a phone number that is not controlled by the defendant): 2) Another phone number to reach you is (list a phone number that is not controlled by the defendant): 3) Email address (list an email address that is not controlled by the defendant): 4) Mailing address: ATTENTION WIRELESS SERVICE PROVIDER Under Kansas law, K.S.A. 66-2020, the information contained on this form is CONFIDENTIAL and must not be disclosed to the defendant (current account holder). American LegalNet, Inc. www.FormsWorkFlow.com