IN THE DISTRICT COURT OF Protection from Abuse (K.S.A. 60-3101 et seq.) COUNTY, KANSAS Modification of Protection from Abuse Order (K.S.A. 60-3107(f)) Judge or Division: Case Number: Court ORI Number: Plaintiff: Plaintiff Identifiers: Year of Birth Relationship to Defendant: are or have been in a dating relationship reside together or formerly resided together have a child in common vs. Defendant: (Date File Stamp) Sex: F M Defendant Identifiers: SEX RACE EYES YOB HT WT Address HAIR LAST 4 DIGITS OF SSN (IF KNOWN) DL STATE DL EXP. DATE DRIVERS LICENSE # Hearing: This matter was not set for hearing. This matter was set for hearing on ___________________, 20_____ and notice was given to the parties. Plaintiff Plaintiff's Attorney Defendant Defendant's Attorney Defendant Does Not Appear Other Appearances: The Court Orders: After review of the file and evidence, the court orders that the attached Final Protection from Abuse Order, entered on ______________________, 20_______, shall be modified as follows:__________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________. All other terms of the original order shall remain in effect. SO ORDERED: Date Judge of the District Court ATTACH THIS MODIFICATION ORDER TO THE ORIGINAL PROTECTION FROM ABUSE ORDER. 07/01/2012 American LegalNet, Inc. www.FormsWorkFlow.com