(1) Form A:

JUVENILE CITATION

COMPLAINT-SUMMONS

State of South Dakota

In Circuit Court

Juvenile Division

County of _________________

_____ Judicial Circuit

State of South Dakota (Plaintiff)

vs.

___________________________

(Juvenile / Defendant)

THE UNDERSIGNED PEACE OFFICER COMPLAINS AND STATES THAT

ON OR ABOUT

AT OR NEAR

AT TIME

A.M.

_____________________

______________________

__________P.M.

WITHIN THE COUNTY AND STATE LISTED ABOVE

NAME

DATE OF BIRTH

_____________________________________

______________________

ADDRESS

______________________________________

______________________________________

DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE(S)

_____  Second Degree Petty Theft ($400 or less), in violation of SDCL 22-30A-17.3

_____ Intentional Damage to Property ($400 or less), in violation of SDCL 22-34-1

_____ Purchase, Possession, or Consumption (_____ PBT) of Alcoholic Beverage by Person

           under 18, in violation of SDCL 35-9-2

_____ Habitual Absence from School by Child of Compulsory School Age, in violation of

           SDCL 26-8B-2(1)

I DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT THIS COMPLAINT/SUMMONS HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IS IN ALL THINGS TRUE AND CORRECT.

____________________________________

_________________________________

Officer Signature

Officer ID

____________________________________

_________________________________

Agency

Date

SUMMONS AND PROMISE TO APPEAR

Juvenile/Defendant is ordered and does promise to appear in the above named court located in the city of ______________________________ on __________________________, 20 ____, at __________________ a.m./p.m.

____________________________________________

Juvenile/Defendant signature

(Signing this form is a promise to appear – Not an admission of guilt. However, failure to appear may be considered an admission to the allegation(s) listed above and a judgement for payment may be entered.)

____ Parent(s)/Guardian Notification ________________________________________

Parent(s)/Guardian information

Name: ____________________________________   _________________________________

Address: __________________________________   _________________________________

City/State/Zip: ______________________________  _________________________________

Phone: _____________________________________

(2) Form B:

UNIFORM TRAFFIC TICKET

SUMMONS-COMPLAINT

PCN ______________

State of South Dakota

____Juvenile Citation*

In Circuit Court

County of _________________

_____Judicial Court

State of South Dakota (Plaintiff)

Vs.

__________________________________

No. __________________HP

(Defendant)

THE UNDERSIGNED PEACE OFFICER COMPLAINS AND STATES THAT

ON OR ABOUT

AT OR NEAR (LOCATION/MILE POST)

AT TIME

A.M.

P.M.

________________________

________________________________

___________

WITHIN THE COUNTY AND STATE AFORESAID

NAME

HEIGHT

SEX

_______________________________

________________

____

ADDRESS

WEIGHT

_______________________________

________________

CITY

STATE

BIRTH DATE

_________________________

________________

____________

DRIVER'S LICENSE NO.

STATE

_________________________

________________

DID

UNLAWFULLY

OPERATE

__________

PARK

______

VEHICLE MAKE

______________

BODY STYLE

____________

STATE LICENSE NO.

YEAR

STATE

FR_____Y

___________________

_______

________

________N

AND THEN AND THERE COMMIT THE FOLLOWING OFFENSE TO WIT:

                      PETTY OFF _____                     MIS ______

DESCRIBE VIOLATION

___________________________________________

CDL ___Y ___N

C Veh. ___Y ___N ___E

___________________________________________

Haz. Materials ___Y ___N

in violation of SDCL _________________________

___Municipal

SPEEDING

___Interstate

___Other

_____M.P.H. IN ____M.P.H. ZONE

OFFICER ISSUING SUMMONS              NO           CITY                        COUNTY       STATE

___________________________                ___           __________              __________    _______

ABOVE COMPLAINT IS TRUE AS I VERILY BELIEVE                                                        DATE

OFFICER SIGN IN PRESENCE OF COURT OR NOTARY

_____________________________________________________                          _____________

SUMMONS and PROMISE TO APPEAR

Defendant is ordered and does promise to appear in the above Court located in the city of __________________ on _________________ at __________  a.m.

                                                                                                       p.m.

X__________________________________________________________________________

Defendant's signature

Signing this form is a promise to appear – Not an admission of guilt. However, failure to appear may be considered an admission to the allegation(s) listed above and a judgment for payment may be entered.

___ Yes ___ No            Court appearance required.

___ Yes ___ No            Power of attorney in lieu of appearance. Amount $ ___________

____Parent(s)/Guardian Notification ____________________________________________

*FOR VIOLATIONS OF SDCL 22-30A-17.3, 22-34-1 (less than $400); 35-9-2; and 26-8B-2(1)