[AGENCY NAME]
[AGENCY ADDRESS]
[AGENCY CASE#]

IN THE 20TH JUDICIAL DISTRICT COURT
BARTON COUNTY, KANSAS

STATE OF KANSAS,	)			
                                      Plaintiff,	)			
vs.	)		District Court Case No. 	
[DEFENDANT’S FULL NAME],	)			
                                      Defendant.	)			
STATE OF KANSAS         )
                                             )  ss:
COUNTY OF BARTON     )

AFFIDAVIT

 I, the undersigned, [Officer’s Name], being of lawful age and first duly sworn and upon my oath, depose and state as follows:
1.	That I am the/a [Title] for the [Law Enforcement Agency], [City], Barton County, Kansas.
2.	At approximately [_____ __.m.] on [incident date], [From your narrative report, include here clear statements that summarize each element that must be proven for the crime(s) committed. Each element summary should be listed under a different paragraph number so your affidavit can be easily read by the judge.]
3.	[Continue your summary with the information supporting the next element of the crime(s) committed.] [A single affidavit may contain all of the probable cause needed to support all the charges for multiple defendants in a single report—even if the defendants have different charges. HOWEVER, an affidavit with an original signature will need to be signed for each defendant]

All of the aforementioned events occurred within Barton County, Kansas.

      FURTHER AFFIANT SAITH NOT.
__________________________________
[Officer’s Name], Affiant

      Sworn to before me this _______ day of ___________________, ______.

                                                                      __________________________________
                                                                       			Notary Public
My Appointment Expires: