7/2018 KSJC Page 1 of 2 IN THE DISTRICT COURT OF COUNTY, KANSAS Protection from Abuse (K.S.A. 60-3101 et seq.) Order Transferring Wireless Telephone Number(s) Pursuant to K.S.A. 66-2020 TO THE WIRELESS SERVICE PROVIDER: Judge or Division: Case Number: Court ORI Number: THE ORDER APPLIES TO: Wireless service provider (name of company): Current account holder (name of defendant): Billing telephone number: New account holder (name of plaintiff): Transfer of the following wireless telephone number(s): Telephone number (include area code): Telephone number (include area code): Telephone number (include area code): Telephone number (include area code): Telephone number (include area code): Check box to include attachment with additional telephone number(s) . TRANSFER OF RIGHTS AND RESPONSIBILITES All rights and responsibilities for the accounts listed above, including all financial responsibility for the telephone numbers, monthly service costs, and costs for any mobile device associated with the telephone numbers, must be immediately transferred to the new account holder. The new account holder will be financially responsible for the accounts listed above starting: the date the account is transferred by the wireless service provider (specify date) The new account holder must send this order and a completed copy of the Confidential Information for Order Transferring Wireless Telephone Number(s) form to the wireless se rvice provider listed above. The Confidential Information for Order Transferring Wireless Telephone Number(s) is a confidential form and must NOT be filed with the court. SO ORDERED: Date Judge of the District Court American LegalNet, Inc. www.FormsWorkFlow.com 7/2018 KSJC Page 2 of 2 ATTENTION WIRELESS SERVICE PROVIDER The new account holder222s contact information, including information on the Confidential Information for Order Transferring Wireless Telephone Number(s), must NOT be disclosed to the current account holder. INSTRUCTIONS FOR WIRELESS SERVICE PROVIDER The orders contained on page 1 of this form must be followed unless the wireless service provider cannot operationally or technically effectuate the order due to certain circumstances, including, but not limited to, any of the following: When the current account holder has already terminated the account, When differences in network technology prevent the functionality of a device on the network, or When there are geography or other limitations on the network or service availability If the provider determines that transfer CANNOT occur, then the provider MUST notify the new account holder. K.S.A. 66-2020. American LegalNet, Inc. www.FormsWorkFlow.com