(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 vs. Case No. ______ Defendant's name Defendant's address Pursuant to Chapter 61 of Kansas Statutes Annotated AFFIDAVIT FOR FORECLOSURE OF SECURED INTEREST ______________, being duly sworn, says that he or she is the plaintiff (or an agent for the corporate plaintiff) in the above-entitled action; that the plaintiff is the holder of an instrument of indebtedness, a copy of which is attached hereto and made a part hereof (or the terms of which are as follows); that the claim of the plaintiff is based on a security agreement, a copy of which is attached hereto and made a part hereof (or the terms of which are as follows); that the amount of indebtedness owed by the defendant to the plaintiff at this time is $________; that the plaintiff is lawfully entitled to the foreclosure of his or her security interest in the following-described personal property; that said personal property is wrongfully detained by the defendant; and that said personal property, together with the estimated value of each article, is described as follows; to wit: Description of Property Estimated Value __________________________________________________ $ ____________________ __________________________________________________ $ ____________________ all of the aggregate value of $ ____________________ Defendant Plaintiff Pursuant to K.S.A. 53-601, as amended, I declare under penalty of perjury that the foregoing is true and correct. American LegalNet, Inc. www.USCourtForms.com EXECUTED on __________________, ______. _____________________________________ Signature American LegalNet, Inc. www.USCourtForms.com