IN THE DISTRICT COURT OF ___________ COUNTY, KANSAS IN THE MATTER OF THE ESTATE OF ______________________________. DECEASED
CASE NO. __________
Comes now, ____________________ of _________________________________________ (Name) (Address) and represents to the court that the estate of the above named decedent, now in process of administration herein, less all credits as shown below or by "Exhibit A" attached hereto(additional pages may be attached if necessary), is indebted to this petitioner as follows: DATE ITEMS DEBTS CREDITS
TOTAL DEBITS & CREDITS NET AMOUNT OF CLAIM XXXXXXXX
WHEREFORE, Petitioner prays the allowance of his demand against said estate to the sum of $ _________ with interest thereon at the rate of ____% per annum from ___________________, ___ to __________________, _____, and the same be assigned to the _________ class; that this court forthwith fix a time and place for the hearing of this petition and order that notice be given as provided by law.
______________________________
(Claimant) VERIFICATION
(To be used by individual Claimant Only)
STATE OF KANSAS, _____________________ COUNTY, SS: _________________________________, of lawful age, being duly sworn upon oath, says that _____ signed the foregoing petition: that _____ knows the contents thereof, and that all the statements therein contained are true. ___________________________________ (Claimant) SUBSCRIBED AND SWORN TO before me this _____________________, _____. ___________________________________ (Name & Title of Court Official-Notary Public VERIFICATION BY AGENT (To be used by Agent or Member of Firm Only) STATE OF KANSAS, ____________________ COUNTY, SS: _________________________________, of lawful age, being duly sworn upon oath, says that he is the agent of the above named petitioner; that the matters and things stated in the foregoing petition are within the personal knowledge of this affiant; that this affiant is duly authorized to make this affidavit and that the allegations contained in said petition are true. ___________________________________ (Claimant) SUBSCRIBED AND SWORN TO before me this _____________________, _____. ___________________________________ (Name & Title of Court Official-Notary Public