(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. Case No. ______ Defendant’s name Defendant Defendant’s address Pursuant to Chapter 61 of Kansas Statutes Annotated TRANSCRIPT OF JUDGMENT This is to certify, that in the District Court of ______________ County, Kansas, in case No. ____, on the ____ day of _____________, ____, judgment was rendered in the above entitled action in favor of ______________, plaintiff (or defendant), against ______________, defendant (or plaintiff) pursuant to the code of civil procedure for limited actions, as follows, to wit: In the principal amount of $_______________ Interest to the date of judgment $_______________ And court costs accrued to this date $_______________ Total amount $_______________ and that said principal amount is to bear interest at ________ until paid. I further certify that to date there has been received by this court from or on behalf of said judgment debtor, to be applied to the judgment, the sum of $________. I further certify that this court has received deposits as security for costs as follows, to wit: From the plaintiff the sum of $_______________ From the defendant the sum of $_______________ American LegalNet, Inc. www.USCourtForms.com For a total cost deposits of $_______________ The following were attorneys of record in this action: For the plaintiff For the defendant _________________________________ Signature, Clerk of the Court Dated: ______________ American LegalNet, Inc. www.USCourtForms.com