(Revised 7/05) 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. Defendant’s name Defendant’s address Case No. ______ Defendant Pursuant to Chapter 61 of Kansas Statutes Annotated PETITION (tort - no attorney fees) The plaintiff states the following claim(s): 1. At all times material the plaintiff was the owner of the following described motor vehicle: ______________________________________________________________________________ _. 2. That on or about ___________________, _______ said motor vehicle was damaged due to the negligent and careless driving of the defendant in the amount of $______. 3. That demand has been made for payment of said damage but the defendant has failed, refused and neglected to pay the same. WHEREFORE, the plaintiff demands judgment against the defendant(s) for: principal amount interest after judgment and costs. $______, ______% per year, _________________________________ Plaintiff or Plaintiff Attorney Signature SC# American LegalNet, Inc. www.USCourtForms.com {If applicable, include the following: This is a communication from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose.} American LegalNet, Inc. www.USCourtForms.com