ࡱ> VXU bjbj@@ R"e1g"e1g $ $ D,ttttcw $ !#ncctt tttY,QМ 0,-$-$-$p-$$ X |: THE CIRCUIT COURT OF ____________ COUNTY, MISSOURI AT KANSAS CITY LANDLORD NAME Plaintiff vs. TENANT NAME Defendant(s) ) ) Case No: __________ ) Division: ____ ) ) ) VERIFICATION OF COMPLIANCE WITH CENTERS FOR DISEASE CONTROL AND PREVENTION ORDER TITLED TEMPORARY HALT IN RESIDENTIAL EVICTIONS TO PREVENT THE FURTHER SPREAD OF COVID-19 NOW COMES the Plaintiff and states as follows: The Plaintiff is seeking to recover possession of the following described premises: INSERT ADDRESS OF PREMISES HERE.  The undersigned has reviewed the Order titled Temporary Halt in Residential Evictions to Prevent the Further Spread of COVID-19 issued by the Centers for Disease Control under Section 361 of the Public Health Service Act and hereby certifies:  FORMCHECKBOX  I have not received an executed copy of a Declaration Form from any of the tenants, lessees, or residents that I am seeking to remove; OR  FORMCHECKBOX  The Order authorizing eviction in this case is based on the tenant, lessee, or resident engaging in criminal activity while on the premises; OR  FORMCHECKBOX  The Order authorizing eviction in this case is based on the tenant, lessee, or resident threatening the health or safety of other residents; OR  FORMCHECKBOX  The Order authorizing eviction in this case is based on the tenant, lessee, or resident damaging or posing an immediate and significant risk of damage to property; OR  FORMCHECKBOX  The Order authorizing eviction in this case is based on the tenant, lessee, or resident violating an applicable building code, health ordinance, or similar regulation relating to health and safety; OR  FORMCHECKBOX  The Order authorizing eviction in this case is based on the tenant, lessee, or resident violating another contractual obligation other than the timely payment of rent or similar housing-related payment (including non-payment or late payment of fees, penalties, or interest.  FORMCHECKBOX  I declare under the penalties of perjury that this verification has been examined by me and that its contents are true to the best of my information, knowledge, and belief. I FURTHER DECLARE, UNDER PENALTIES OF PERJURY, THAT I HAVE PROVIDED AN EXECUTED COPY OF THIS VERIFICATION TO ALL TENANTS, LESSEES OR RESIDENTS THAT I AM SEEKING TO REMOVE. NOTICE TO TENANTS, LESSEES OR RESIDENTS IF YOU CONTEST THE ACCURACY OF THE STATEMENTS IN THIS VERIFICATION, YOU MUST FILE A MOTION/NOTICE WITH THE COURT, IN THE CASE NUMBER STATED ABOVE, WITHIN SEVEN (7) DAYS OF RECEIVING THIS VERIFICATION. IF NO MOTION/NOTICE IS FILED, THE COURT MAY PROCEED WITH EVICTION BASED ON THE STATEMENTS IN THIS VERIFICATION. Respectfully Submitted, By: ________________________ LANDLORD NAME Mailing Certificate The undersigned hereby certifies that a copy of the foregoing was mail by regular, postage-paid mail, on DATE, to: TENANT NAME TENANT ADDRESS CITY, STATE ZIP Tenant ________________________ LANDLORD NAME !"23ABCDLMQR\]`abmn{|}~ճ'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh#hQ9h< X5>*CJ\aJwh *h&h&h&h< X h:h< Xh&mHnHu *h&h&mHnHuh |h< XmHnHu03BCDR]abn|~\ ]  $Ifgd-gd-$a$gd-@&gdgd$@&a$$a$űŝʼnuaʼnu'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh#hQ9h< X5>*CJ\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh           °t`L'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh#hQ9h< X5>*CJ\aJwh%hQ9h< X5>*@CJRHc\aJ+hQ9h< X5>*@CJRHc\aJwh'hQ9h< X5>*CJRHc\aJwh  ! " ' ( 1 2 4 5 7 8 < = > @ A ٱٝىu_K5+hQ9h< X5>*@CJRHc\aJwh'hQ9h< X5>*CJRHc\aJwh+hQ9h< X5>*@CJRHc\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh#hQ9h< X5>*CJ\aJwh'hQ9h< X5>*@CJ\aJwhA H I O P R S U V [ \ ]        İĜֈyngggggZLBZZZggh[CJPJaJ *h[h[CJPJaJh:h< XCJPJaJ h:h< Xh:h< X5>*\hQ9h< X5>*CJ\aJ'hQ9h< X5>*CJRHc\aJwh'hQ9h< X5>*@CJ\aJwh'hQ9h< X5>*@CJ\aJwh#hQ9h< X5>*CJ\aJwh+hQ9h< X5>*@CJRHc\aJwh%hQ9h< X5>*@CJRHc\aJ     oeN$24Ad]2^4`Aa$gd } dgd }$04d]0^4a$gd }gd-nkd$$Iflm%h% t0644 lap yt- $Ifgd-      # $ ' ( - . 4 5 8 9 ? @ D E G H S T ] ^ _ ` a h i l m { | ~  h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@h< X?             $ % ' ( 0 1 5 6 ƻʤzt h< X@ h< X@ h< X@ h< X@ h< X@"h< X@CJOJPJQJ^JaJh2#h< XB*mH ph333sH jhtAUjhtAUh&jh&U h< X@ h< X@ h< X@ h< X@ h< X@ h< X@h< X h< X@-6 8 9 : ; > ? F G K L N O P Q R S T U W X [ \ d e i j m n p q z {  h2#h< XB*mH ph333sH jhtAUjhtAU h2#h< Xjh2#h< XU h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@h< X7 @ A ~nd d$ gd }$14Ad]1^4`Aa$gd } d$gd }$24Ad]2^4`Aa$gd }$14Ad]1^4`Aa$gd }$34Ad]3^4`Aa$gd } d$gd }$34Ad]3^4`Aa$gd } dgd }           + , . / 2 3 6 7 < = h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X"h< X@CJOJPJQJ^JaJ8= ? @ A B P Q R S T ] ^ _ ` i j m n r s u v  h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@h2#h< XB*mH ph333sH jhtAUjjhtAU h2#h< Xjh2#h< XUh< X9           " # $ % ' ( + , - . 0 1 4 5 < = A B D E F G H P Q ȶz h< X@ h< X@$ h< X@% h< X@* h< X@& h< X@( h< X@# h< X@ h< X@ h< X@'"h< X@CJOJPJQJ^JaJh2#h< XB*mH ph333sH jhtAUjhtAU h2#h< Xjh2#h< XUh< X0Q R S Y Z \ ] c d i j p q r s t u z"h< X@CJOJPJQJ^JaJh2#h< XB*mH ph333sH jhtAUjRhtAU h2#h< Xjh2#h< XU h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@$ h< X@( h< X@! h< X@h< X/   "#*+-.1234:;>@EFHIKLPQ[\ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@& h< X@( h< X@, h< X@ h< X@- h< X@* h< X@' h< X@$ h< X@)h< X h< X@+;\deghijnorsxyz{}~ƻͤztnn h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ "h< X@CJOJPJQJ^JaJh2#h< XB*mH ph333sH jhtAUjhtAU h2#h< Xjh2#h< XU h< X@ h< X@ h< X@ h< X@ h< X@ h< X@h< X("#%&)*+,-.12459:<=?@DETU\]`aghijmno h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X h< X@Bostvw~ʨ~ h< X@ h< X@ h< X@ h< X@"h< X@CJOJPJQJ^JaJh2#h< XB*mH ph333sH jhtAUj:htAUjh< XU h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@h< X1  '(+,3478<=>?@ABCHIOPQRZ[^_bchijknorsh< X5@\h< X5@\h< X5@%\ h< X5\ h< X@ h< X@ h< X@ h< X@! h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@ h< X@h< X9stuvw{|~h< X5@ \h< X5@ \h< X5@ \h< X5@\h< X5@ \h< X5@\h< X5@\h< X5@ \h< X5@\h< X5@\h< X5@\h< X5@\h< X5@\ h< X5\3      #$%&()0134𶶤|h|h'h }h< X5>*@ CJ\aJwh'h }h< X5>*@CJ\aJwh'h }h< X5>*@CJ\aJwh#h }h< X5>*CJ\aJwhh< Xh< X5@\h< X5@\h< X5@\h< X5@\h< X5@\h< X5@\ h< X5\h< X5@\(|}nogd `gd $da$gd  gdM"`gd&`gd- $da$gd-gd-$a$gd } d$gd }$04Ad]0^4`Aa$gd }489=>?@BCFGHJKNORSTVWYZ^_aijmnɻ{{k{{{[{{Kh }h< X5@CJ\aJh }h< X5@ CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@ CJ\aJh }h< X5@ CJ\aJh }h< X5CJ\aJh }h< X5@ CJ\aJ'h }h< X5>*@CJ\aJwh#h }h< X5>*CJ\aJwhnpquvrbh }h< X5@CJ\aJh }h< X5@ CJ\aJh }h< X5@ CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5CJ\aJ#   rbh }h< X5@-CJ\aJh }h< X5@ CJ\aJh }h< X5@CJ\aJh }h< X5@ CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5CJ\aJh }h< X5@CJ\aJ% !"#$%&(),-.0123456789;<>?BLMRrh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@ CJ\aJh }h< X5@CJ\aJh }h< X5@ CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5CJ\aJh }h< X5@CJ\aJ&RSUVYZ[\]^deghlmnoz{|}∈}}}}ukcX}}h:h< X6>*]h[h[6h[h[6]h[h< X6 h:h< Xh&h:h< X5\h }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5@CJ\aJh }h< X5CJ\aJh }h< X5@CJ\aJ!dhmnozǹh[h< X6]h[h< X6 h[h< Xh& *h&h< XmHnHu *h&h[mHnHu h&h< X *h&h&mHnHuh< X5>*B*ph h< X5>*h< X# gdM" ^gd m$gd `gd ?0P1h:p< X/ =!"#$#% DpK 01h:p'/ =!"#$% P0 Zp5 01h:p,7/ =!"#$&% 5 01h:p< X/ =!"#$&% $$Ifq!vh#vh%:V l t065h%p yt-tDeCheck2tDeCheck2tDeCheck2tDeCheck2tDeCheck2tDeCheck2hDex666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List NYN  Document MapM OJQJ^J6U 6  Hyperlink >*B*phPP R0 Balloon TextCJOJQJaJmHsHtHN/!N R0Balloon Text CharCJOJQJ^JaJv 3v - Table Grid7:V0 CJPJaJPBP - List Paragraph ^m$ CJPJaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vj\{cp/IDg6wZ0s=Dĵw %;r,qlEآyDQ"Q,=c8B,!gxMD&铁M./SAe^QשF½|SˌDإbj|E7C<bʼNpr8fnߧFrI.{1fVԅ$21(t}kJV1/ ÚQL×07#]fVIhcMZ6/Hߏ bW`Gv Ts'BCt!LQ#JxݴyJ] C:= ċ(tRQ;^e1/-/A_Y)^6(p[_&N}njzb\->;nVb*.7p]M|MMM# ud9c47=iV7̪~㦓ødfÕ 5j z'^9J{rJЃ3Ax| FU9…i3Q/B)LʾRPx)04N O'> agYeHj*kblC=hPW!alfpX OAXl:XVZbr Zy4Sw3?WӊhPxzSq]y D  !R!AR!R!R A  6 = Q \os4n R  "#$%&'  !( AQR GGGGGGGL# @0(  B S  ?Check2    <?0^`0o(.^`. L ^ `L.  ^ `.xx^x`.HLH^H`L.^`.^`.L^`L.<?T        qB %?7BLBBkLL]BaubBmW^vr\FxWW_z |i}BV R2 P--[,@S,hfO*4c$%9&A&Ug&W.&5,7Q9U;(<%>tA7jD%CKTkM }M7UKV< XofSg31o~q.yz !|E| }^8uTi'HU" G&,xS}:h)+ $[O*]X M"Mxh_MEKaRr@{XMw &C  @ @UnknownG.[x Times New Roman5Symbol3. .[x Arial7..{$ CalibriG.Segoe UI Symbol5& .[`)TahomaC.,.{$ Calibri LightACambria Math"h#;g#;gD#g8 8 !r0 C@P  $PO*2!xx\ IN THE CIRCUIT COURT OF STjbuHolly Oh+'0  0 < H T`hpxIN THE CIRCUIT COURT OF STjbu Normal.dotmHolly2Microsoft Office Word@@ٝ@zl.М@zl.М8  ՜.+,0 hp|  Jay  IN THE CIRCUIT COURT OF ST Title  !"#$%&'()+,-./013456789:;<=>?@ABCDFGHIJKLNOPQRSTWRoot Entry F5QМYData *1Table2=$WordDocumentRSummaryInformation(EDocumentSummaryInformation8MCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q