Transcript
IN THE DISTRICT COURT OF
JUDICIAL DISTRICT COUNTY, KANSAS
IN THE MATTER OF THE MARRIAGE OF , Petitioner, Case No. and , Respondent.
AFFIDAVIT REQUESTING ORDER RESTORING NAME moves the Court to restore: “
My maiden name of
“
My previous married name of
. .
VERIFICATION
I verify under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct. Executed on ______________, 20___.
__________________________________________ Signature Name Print):__________________________________ Address (1):___________________________________ Address (2):___________________________________ City, ST, Zip:__________________________________ Telephone:____________________________________
Authority: K.S.A. 23-2716.
KSJC 8/2012
IN THE DISTRICT COURT OF
JUDICIAL DISTRICT COUNTY, KANSAS
IN THE MATTER OF THE MARRIAGE OF , Petitioner, Case No. and , Respondent.
ORDER ON the
day of
, 20
, the Court
considers the application of the “ Petitioner “ Respondent for restoration of “ maiden “ previous married name. Having reviewed the affidavit, the Court orders that the “ Petitioner’s “ Respondent’s name be restored to
.
IT IS SO ORDERED.
Judge
Authority: K.S.A. 23-2716.
KSJC 8/2012
