(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 Judgment Creditor In The District Court of ______ County, Kansas Judgment Creditor name vs. Judgment Debtor name Judgment Creditor Case No. ______ Judgment Debtor Type of Service Requested: ______________________ by ________________________ CITATION FOR CONTEMPT TO: Judgment Debtor Name Judgment Debtor Address It has been made to appear to the Court that you were lawfully served with an Order to Appear before this Court and failed to appear at the time and place specified in the Order. THEREFORE, you are hereby commanded to personally appear before this Court at ______ __.m. on _________________, ______, at the following location: ______________________________________________________________________________ ______________________________________________________________________________ TO SHOW CAUSE WHY YOU SHOULD NOT BE PUNISHED FOR CONTEMPT OF COURT for your failure to appear as set forth above. Please bring these papers with you. Dated: __________________, ________. _________________________________ JUDGE {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.FormsWorkFlow.com RETURN I hereby certify that I have served this document in the following manner: (1) Personal Service. By delivering a copy of such document to each of the following defendants on the dates indicated: _______________ _______________, ______ _______________ _______________, ______ (2) Residence Service. By leaving a copy of such 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 dates indicated: ____________________ ____________________ ___________, ______ ____________________ ____________________ ___________, ______ (Name) (Address) (Date) (3) Agent Service. By delivering a copy of such document to each of the following agents authorized by appointment or by law to receive service of process on the dates indicated: ____________________ _______________, ______ ____________________ _______________, ______ (Name) (Date) (4) Residence Service and Mailing. By leaving a copy of such 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: ____________________ ____________________ ____________, ______ ____________________ ____________________ ____________, ______ (Name) (Address) (Date) (5) Service by Return Receipt Delivery. By causing to be delivered on the _____ day of _______________, ______, a copy of the summons and petition by return receipt delivery to each of the following defendants at the following address:______________________________________________ ____________________________________________________________________________________ with such delivery made by the following person or entity: _______________________________. Attached hereto is a copy of the return receipt evidencing such delivery. (6) Return Receipt Delivery Refused. By mailing on the _____ day of _______________, _____, a copy of the summons and petition by first-class mail, postage prepaid, addressed to the following at the following address: ____________________________________________________________________ ____________________________________________________________________________________ (7) No Service. The following defendants were not served: _________________________________________________________________________________ Pursuant to K.S.A. 53-601, as amended, I declare under penalty of perjury that the foregoing is true and correct. EXECUTED on __________________, ______. _____________________________________ Signature & Title of Officer or Process Server American LegalNet, Inc. www.FormsWorkFlow.com