<html> <head> <title>Rule 02:03:01:05 Forms for juvenile cited violations.</title> <META NAME="Keywords" Content="Administrative Rules 02:03:01:05"> <META NAME="Description" Content="Administrative Rules 02:03:01:05 Forms for juvenile cited violations."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times","serif";} @page WordSection1 {size:8.5in 11.0in; margin:49.7pt 1.0in 49.7pt 63.35pt;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><a name="_GoBack"></a><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>2:03:01:05.&nbsp;&nbsp;Forms for juvenile cited violations.</b> Either Form A or B, or any other form that substantially complies with Form A or B, shall be used as a summons and complaint for juvenile cited violations.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> <table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0 style='border-collapse:collapse;border:none'> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>(1) <u>Form A</u>:</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>JUVENILE CITATION</span></b></p> <p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>COMPLAINT-SUMMONS</span></b></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>State of South Dakota</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>In Circuit Court</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>Juvenile Division</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>County of _________________</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>_____ Judicial Circuit</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>State of South Dakota (Plaintiff)</span></p> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>vs.</span></p> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>___________________________</span></p> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>(Juvenile / Defendant)</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>THE UNDERSIGNED PEACE OFFICER COMPLAINS AND STATES THAT</span></p> </td> </tr> <tr> <td width=217 valign=top style='width:162.45pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>ON OR ABOUT</span></p> </td> <td width=217 colspan=2 valign=top style='width:162.5pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>AT OR NEAR</span></p> </td> <td width=217 valign=top style='width:162.5pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>AT TIME</span></p> </td> </tr> <tr> <td width=217 valign=top style='width:162.45pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=217 colspan=2 valign=top style='width:162.5pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=217 valign=top style='width:162.5pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>A.M.</span></p> </td> </tr> <tr> <td width=217 valign=top style='width:162.45pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>_____________________</span></p> </td> <td width=217 colspan=2 valign=top style='width:162.5pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>______________________</span></p> </td> <td width=217 valign=top style='width:162.5pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>__________P.M.</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>WITHIN THE COUNTY AND STATE LISTED ABOVE</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>NAME</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>DATE OF BIRTH</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>_____________________________________</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>______________________</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>ADDRESS</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>______________________________________</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>______________________________________</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>DID THEN AND THERE COMMIT THE FOLLOWING OFFENSE(S)</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>_____&nbsp; Second Degree Petty Theft ($400 or less), in violation of SDCL 22-30A-</span><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>17.3</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>_____ Intentional Damage to Property ($400 or less), in violation of SDCL 22-</span><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>34-1</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>_____ Purchase, Possession, or Consumption (_____ PBT) of Alcoholic Beverage by Person</span></p> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; under 18, in violation of SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=35-9-2">35-9-2</A></span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>_____ Habitual Absence from School by Child of Compulsory School Age, in violation of</span></p> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=26-8B-2">26-8B-2(1)</A></span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify;text-autospace:none'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>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.</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>____________________________________</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>_________________________________</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>Officer Signature</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>Officer ID</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>____________________________________</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>_________________________________</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>Agency</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>Date</span></p> </td> </tr> <tr> <td width=325 colspan=2 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=325 colspan=2 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center;text-autospace:none'><b><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>SUMMONS AND PROMISE TO APPEAR</span></b></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>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.</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>____________________________________________</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>Juvenile/Defendant signature</span></p> <p class=MsoNormal style='text-align:justify;text-autospace:none'><span style='font-size:12.5pt;font-family:"Times New Roman","serif"'>(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.)</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>____ Parent(s)/Guardian Notification ________________________________________</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>Parent(s)/Guardian information</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>Name: ____________________________________&nbsp;&nbsp; _________________________________</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>Address: __________________________________&nbsp;&nbsp; _________________________________</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>City/State/Zip: ______________________________&nbsp; _________________________________</span></p> </td> </tr> <tr> <td width=650 colspan=4 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-autospace:none'><span style='font-size:12.5pt; font-family:"Times New Roman","serif"'>Phone: _____________________________________</span></p> </td> </tr> <tr height=0> <td width=232 style='border:none'></td> <td width=116 style='border:none'></td> <td width=108 style='border:none'></td> <td width=217 style='border:none'></td> </tr> </table> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> <span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><br clear=all style='page-break-before:always'> </span> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> <table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0 style='border-collapse:collapse;border:none'> <tr> <td width=325 colspan=7 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>(2) <u>Form B</u>:</span></p> </td> <td width=325 colspan=7 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>UNIFORM TRAFFIC TICKET</span></b></p> <p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>SUMMONS-COMPLAINT</span></b></p> </td> </tr> <tr> <td width=325 colspan=7 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>PCN ______________</span></p> </td> <td width=325 colspan=7 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=325 colspan=7 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>State of South Dakota</span></p> </td> <td width=325 colspan=7 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>____Juvenile Citation*</span></p> </td> </tr> <tr> <td width=325 colspan=7 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=325 colspan=7 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>In Circuit Court</span></p> </td> </tr> <tr> <td width=325 colspan=7 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>County of _________________</span></p> </td> <td width=325 colspan=7 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>_____Judicial Court</span></p> </td> </tr> <tr> <td width=325 colspan=7 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>State of South Dakota (Plaintiff)</span></p> </td> <td width=325 colspan=7 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=325 colspan=7 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>Vs.</span></p> </td> <td width=325 colspan=7 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=325 colspan=7 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>__________________________________</span></p> </td> <td width=325 colspan=7 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>No. __________________HP</span></p> </td> </tr> <tr> <td width=325 colspan=7 valign=top style='width:243.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>(Defendant)</span></p> </td> <td width=325 colspan=7 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>THE UNDERSIGNED PEACE OFFICER COMPLAINS AND STATES THAT</span></p> </td> </tr> <tr style='height:13.15pt'> <td width=217 colspan=4 valign=top style='width:162.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.15pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>ON OR ABOUT</span></p> </td> <td width=301 colspan=8 valign=top style='width:225.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.15pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>AT OR NEAR (LOCATION/MILE POST)</span></p> </td> <td width=133 colspan=2 valign=top style='width:99.55pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.15pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>AT TIME</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=217 colspan=4 valign=top style='width:162.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=301 colspan=8 valign=top style='width:225.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=133 colspan=2 valign=top style='width:99.55pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>A.M.</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=217 colspan=4 valign=top style='width:162.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=301 colspan=8 valign=top style='width:225.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=133 colspan=2 valign=top style='width:99.55pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>P.M.</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=217 colspan=4 valign=top style='width:162.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>________________________</span></p> </td> <td width=301 colspan=8 valign=top style='width:225.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>________________________________</span></p> </td> <td width=133 colspan=2 valign=top style='width:99.55pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>___________</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>WITHIN THE COUNTY AND STATE AFORESAID</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=277 colspan=6 valign=top style='width:207.6pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>NAME</span></p> </td> <td width=222 colspan=5 valign=top style='width:166.8pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>HEIGHT</span></p> </td> <td width=151 colspan=3 valign=top style='width:113.05pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>SEX</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=277 colspan=6 valign=top style='width:207.6pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>_______________________________</span></p> </td> <td width=222 colspan=5 valign=top style='width:166.8pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>________________</span></p> </td> <td width=151 colspan=3 valign=top style='width:113.05pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>____</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=277 colspan=6 valign=top style='width:207.6pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>ADDRESS</span></p> </td> <td width=222 colspan=5 valign=top style='width:166.8pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>WEIGHT</span></p> </td> <td width=151 colspan=3 valign=top style='width:113.05pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=277 colspan=6 valign=top style='width:207.6pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>_______________________________</span></p> </td> <td width=222 colspan=5 valign=top style='width:166.8pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>________________</span></p> </td> <td width=151 colspan=3 valign=top style='width:113.05pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=277 colspan=6 valign=top style='width:207.6pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>CITY</span></p> </td> <td width=222 colspan=5 valign=top style='width:166.8pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>STATE</span></p> </td> <td width=151 colspan=3 valign=top style='width:113.05pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>BIRTH DATE</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=277 colspan=6 valign=top style='width:207.6pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>_________________________</span></p> </td> <td width=222 colspan=5 valign=top style='width:166.8pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>________________</span></p> </td> <td width=151 colspan=3 valign=top style='width:113.05pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>____________</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=277 colspan=6 valign=top style='width:207.6pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>DRIVER'S LICENSE NO.</span></p> </td> <td width=222 colspan=5 valign=top style='width:166.8pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>STATE</span></p> </td> <td width=151 colspan=3 valign=top style='width:113.05pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=277 colspan=6 valign=top style='width:207.6pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>_________________________</span></p> </td> <td width=222 colspan=5 valign=top style='width:166.8pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>________________</span></p> </td> <td width=151 colspan=3 valign=top style='width:113.05pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=130 valign=top style='width:97.45pt;border:none;padding:0in 5.4pt 0in 5.4pt; height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=130 colspan=4 valign=top style='width:97.5pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=130 colspan=4 valign=top style='width:97.5pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=145 colspan=4 valign=top style='width:108.95pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=115 valign=top style='width:86.05pt;border:none;padding:0in 5.4pt 0in 5.4pt; height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=130 valign=top style='width:97.45pt;border:none;padding:0in 5.4pt 0in 5.4pt; height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>DID</span></p> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>UNLAWFULLY</span></p> </td> <td width=130 colspan=4 valign=top style='width:97.5pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>OPERATE</span></p> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>__________</span></p> </td> <td width=130 colspan=4 valign=top style='width:97.5pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>PARK</span></p> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>______</span></p> </td> <td width=145 colspan=4 valign=top style='width:108.95pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>VEHICLE MAKE</span></p> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>______________</span></p> </td> <td width=115 valign=top style='width:86.05pt;border:none;padding:0in 5.4pt 0in 5.4pt; height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>BODY STYLE</span></p> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>____________</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=187 colspan=3 valign=top style='width:1.95in;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=138 colspan=4 valign=top style='width:103.3pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=162 colspan=3 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=163 colspan=4 valign=top style='width:121.9pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=187 colspan=3 valign=top style='width:1.95in;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>STATE LICENSE NO.</span></p> </td> <td width=138 colspan=4 valign=top style='width:103.3pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>YEAR</span></p> </td> <td width=162 colspan=3 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>STATE</span></p> </td> <td width=163 colspan=4 valign=top style='width:121.9pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>FR_____Y</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=187 colspan=3 valign=top style='width:1.95in;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>___________________</span></p> </td> <td width=138 colspan=4 valign=top style='width:103.3pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>_______</span></p> </td> <td width=162 colspan=3 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>________</span></p> </td> <td width=163 colspan=4 valign=top style='width:121.9pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>________N</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>AND THEN AND THERE COMMIT THE FOLLOWING OFFENSE TO WIT:</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; PETTY OFF _____&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; MIS ______</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>DESCRIBE VIOLATION</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=385 colspan=8 valign=top style='width:288.9pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>___________________________________________</span></p> </td> <td width=265 colspan=6 valign=top style='width:198.55pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>CDL ___Y ___N</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=385 colspan=8 valign=top style='width:288.9pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=265 colspan=6 valign=top style='width:198.55pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>C Veh. ___Y ___N ___E</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=385 colspan=8 valign=top style='width:288.9pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>___________________________________________</span></p> </td> <td width=265 colspan=6 valign=top style='width:198.55pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Haz. Materials ___Y ___N</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=385 colspan=8 valign=top style='width:288.9pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>in violation of SDCL _________________________</span></p> </td> <td width=265 colspan=6 valign=top style='width:198.55pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=162 colspan=2 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=162 colspan=5 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=162 colspan=3 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=163 colspan=4 valign=top style='width:121.9pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=162 colspan=2 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=162 colspan=5 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>___Municipal</span></p> </td> <td width=162 colspan=3 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=163 colspan=4 valign=top style='width:121.9pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=162 colspan=2 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>SPEEDING</span></p> </td> <td width=162 colspan=5 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>___Interstate</span></p> </td> <td width=162 colspan=3 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=163 colspan=4 valign=top style='width:121.9pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=162 colspan=2 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> <td width=162 colspan=5 valign=top style='width:121.85pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>___Other</span></p> </td> <td width=325 colspan=7 valign=top style='width:243.75pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>_____M.P.H. IN ____M.P.H. ZONE</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>OFFICER ISSUING SUMMONS&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; NO&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; CITY&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; COUNTY&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; STATE</span></p> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>___________________________&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ___&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; __________&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; __________&nbsp;&nbsp;&nbsp; _______</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>ABOVE COMPLAINT IS TRUE AS I VERILY BELIEVE&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; DATE</span></p> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>OFFICER SIGN IN PRESENCE OF COURT OR NOTARY</span></p> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>_____________________________________________________&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; _____________</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></b></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>SUMMONS and PROMISE TO APPEAR</span></b></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Defendant is ordered and does promise to appear in the above Court located in the city of __________________ on _________________ at __________&nbsp; a.m.</span></p> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; p.m.</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>X__________________________________________________________________________</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Defendant's signature</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>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.</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>___ Yes ___ No&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Court appearance required.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>___ Yes ___ No&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Power of attorney in lieu of appearance. Amount $ ___________</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>____Parent(s)/Guardian Notification ____________________________________________</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:13.05pt'> <td width=650 colspan=14 valign=top style='width:487.45pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:13.05pt'> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>*FOR VIOLATIONS OF SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=22-30A-17.3">22-30A-17.3</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=22-34-1">22-34-1</A> (less than $400); 35-9-2; and 26-8B-2(1)</span></p> </td> </tr> <tr height=0> <td width=130 style='border:none'></td> <td width=33 style='border:none'></td> <td width=25 style='border:none'></td> <td width=29 style='border:none'></td> <td width=43 style='border:none'></td> <td width=17 style='border:none'></td> <td width=48 style='border:none'></td> <td width=60 style='border:none'></td> <td width=5 style='border:none'></td> <td width=97 style='border:none'></td> <td width=12 style='border:none'></td> <td width=18 style='border:none'></td> <td width=18 style='border:none'></td> <td width=115 style='border:none'></td> </tr> </table> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 42 SDR 101, effective January 11, 2016.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=23-1A-2.1">23-1A-2.1</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=23-1A-2">23-1A-2.</A></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=23-1A-2.1">23-1A-2.1</A></span></p> <p class=MsoNormal>&nbsp;</p> </div> </body> </html>