Sample Standard Petition/Medical Petition

Prepared By:
JOHN DOE, #12345
Attorney at Law, P.A.
200 SE 7 ST
TOPEKA, KS  66603
(785) 233-8200
Attorney for Plaintiff



              IN THE DISTRICT COURT OF SHAWNEE COUNTY, KANSAS
                         LIMITED ACTIONS DIVISION



EAT AT JOE'S                                       ) Plaintiff
                                                   )
              vs.                                  ) Case Number 99L 000002
                                                   ) Division No. 06
JANE Q PUBLIC                     SSN 123-45-6789  ) DOB ________
123 NW ANY ST                                      )
TOPEKA, (SHAWNEE County), KS  66601                ) Defendant(s)

Service By: Certified Mail

                              P E T I T I O N

COMES NOW the Plaintiff and states and alleges the following:

1. That defendant(s) has a correct post office address and may be served as
set out above.

2. That plaintiff states that the defendant is indebted to the plaintiff in
the sum of $446.40.  That demand has been made upon defendant.

    WHEREFORE, Plaintiff prays for judgment against Defendant in the amount
of $446.40 with interest at the statutory rate per annum from 06/30/99 to
date of judgment and at the statutory rate from date of judgment, for cost
of this action, and for such other relief as may be just and equitable.

                                             ______________________________
                                                           JOHN DOE, #12345

** This is a communication from a debt collector. This is an attempt to
collect a debt and any information obtained wil be used for that
purpose.***

(mdpsnks 01-97)

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