F 3.405(H) IN THE DISTRICT COURT OF SHAWNEE COUNTY, KANSAS ______________________________ **CAPTION** vs. ______________________________ ) ) ) ) ) ) ) Case No. [Case Number] Document No. _____________ CITATION IN CONTEMPT (Failure to Pay) To: [Debtor Name] [Debtor Address] ___________________ ___________________ It has been made to appear to the Court that you willfully and without good cause failed or refused to comply with the order of this Court, ordering you to pay support. YOU ARE THEREFORE COMMANDED TO BE AND APPEAR BEFORE THE COURT on __________________________, 20____, AT ____:_____ __.M. at the Shawnee County Courthouse, 200 S. E. 7th, Topeka, Kansas, and show cause, if any you may have, why you should not be found in contempt and incarcerated until you comply with said order of the Court. FAILURE TO APPEAR IN RESPONSE TO THIS ORDER WILL RESULT IN A WARRANT BEING ISSUED FOR YOUR ARREST. Dated: ________________, 20___ ___________________________________ JUDGE OF THE DISTRICT COURT ________________________ Official Seal of the District Court Angela M. Callahan Shawnee County, Kansas Clerk of the District Court 29 January MDCCCLXI --------------------------------------Prepared and Approved by: ___________________________________ ________________________________________ Deputy Clerk ________________________________________ ________________________________________ Attorney for Movant Personal service on: [SUPPORT OBLIGOR'S NAME] American LegalNet, Inc. www.FormsWorkflow.com RETURN OF SERVICE I hereby certify that I have served this document: (1) PERSONAL SERVICE: By delivering a copy of said document to each of the following defendants on the date indicated: (2) RESIDENCE SERVICE: By leaving a copy of said document at the usual place of residence of each of the following defendants with some person of suitable age and discretion residing therein on the date indicated: (3) AGENT SERVICE: By delivering a copy of said document to each of the following agents authorized by appointment or by law to receive service of process on the date indicated: (4) RESIDENCE SERVICE AND MAILING: By leaving a copy of said document at the usual place of residence of each of the following defendants and mailing by first-class mail on the dates indicated a notice that such copy has been so left: (5) CERTIFIED MAIL SERVICE: I hereby certify that I have served the within document: (1) By mailing on the ___ day of ___________, 20__ , a copy of the said document in the above action as certified mail return receipt requested to each of the within-named defendants: (2) the name and address on the envelope containing the process mailed as certified mail return receipt requested were as follows: (6) FIRST CLASS MAIL SERVICE: I hereby certify that I have served the documents described (or listed on the attached list) by first class mail, postage prepaid, to each of the named defendants: (7) CERTIFIED MAIL SERVICE REFUSED: I hereby certify that on the ___ day of ___________, 20__ , I mailed a copy of the said document in the above action by first-class mail, postage prepaid, addressed to: (8) AVOIDANCE OF SERVICE: After diligent effort, I am satisfied that the following defendants are secreting themselves in order to avoid the process of the court: (9) NO SERVICE: The following defendants were not found in this county: Date Served:______________________ Return to: Clerk of the District Court 200 SE 7th, Suite 209 Topeka, Kansas 66603-3968 (785) 233-8200 Ext. 5159 ________________________________ (Signature and Title of Officer) Case No. [Case Number Served] CITATION IN CONTEMPT FAILURE TO PAY American LegalNet, Inc. www.FormsWorkflow.com