Rev. 6/2017 KSJC 1 [CAPTION] PETITION ON A PROMISSORY NOTE Plaintiff (name) states the following claim for relief against the defendant, (name) : 1. On or about (date) defendant executed and delivered to plaintiff a promissory note, (providing that: [summarize the obligation]) (a copy of which is attached as Exhibit A). 2. Defendant is in default on the note. 3. Defendant owes to plaintiff the amount of $ with interest on the note. Wherefore, plaintiff demands judgment against defendant in the amount of $, together with interest, costs of this action, and other appropriate relief. (Signature of Attorney) (Name), Attorney for (name of plaintiff) Bar Registration Number Address Telephone number [Facsimile number] [Email address] Authority K.S.A. 60-208; K.S.A. 60-209(h); K.S.A 60-210 American LegalNet, Inc. www.FormsWorkFlow.com