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Kansas Poverty Affidavit 2013-2023
In this matter by reason of poverty. Pursuant to K.S.A. 60-2001(b)(2),
the following information is provided in support.
Employment: I am ___ employed; ___ not employed.
My employer is:
_______________________________
My employer’s address is:
_______________________________
_______________________________
_______________________________
Income: I receive income from the following other sources (list amount per week):
Employment income (after withholdings) is:
$____________
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