Kansas Code § 12-4204

Notice to appear; contents; form
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A notice to appear shall describe the offense charged, shall summon the accused person to appear, shall contain a space in which the accused person may agree, in writing, to appear at a time not less than five (5) days after such notice to appear is given, unless the accused person shall demand an earlier hearing. A notice to appear may be signed by a municipal judge, the clerk of the municipal court, the city attorney, or any law enforcement officer of the city.
A notice to appear shall be deemed sufficient if in substantially the form of the notice to appear set out in K.S.A. 12-4205 or if in substantially the following form, to wit:
OF __________, KANSAS
(Accused person)
(Address)
If you fail to appear a warrant will be issued for your arrest.
Dated __________, 19__.
I agree to appear in said Court at said time and place.
The undersigned hereby certifies that on the ____ day of __________, 19__, the notice to appear was served, mailed or delivered.

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