<html> <head> <title>Rule 02:03:01:01 Forms for petty offense complaints and summons.</title> <META NAME="Keywords" Content="Administrative Rules 02:03:01:01"> <META NAME="Description" Content="Administrative Rules 02:03:01:01 Forms for petty offense complaints and summons."> <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-top:0in; margin-right:0in; margin-bottom:10.0pt; margin-left:0in; line-height:115%; font-size:11.0pt; font-family:"Calibri","sans-serif";} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><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</b><b>:01.&nbsp;&nbsp;Forms for petty offense complaints and summons.</b> Either Form A or B, or any other form that substantially complies with Form A or B, shall be used as a petty offense summons and complaint. If Form A is used, a power of attorney form in substantial compliance with &#167;&nbsp;2:03:01:03 shall be attached.</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; If a law enforcement agency designated in &#167;&nbsp;2:03:01:04 chooses to use the declaration option set forth in SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=23-1A-5">23-1A-5</A>, either Form A or B, or any other form that substantially complies with Form A or B, may be modified by inserting the statutorily approved declaration above the officer's signature in addition to or in lieu of the oath acknowledgment.</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:9.0pt;font-family:"Times","serif"'>(1) <u>Form A</u>:</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:9.0pt;font-family:"Times","serif"'>&nbsp;</span></p> <table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0 style='border-collapse:collapse;border:none'> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><b><span style='font-size:9.0pt; font-family:"Times","serif"'>UNIFORM TRAFFIC TICKET</span></b></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><b><span style='font-size:9.0pt; font-family:"Times","serif"'>SUMMONS-COMPLAINT</span></b></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:8.0pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>PCN ______________</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>State of South Dakota </span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>In Circuit Court</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>Magistrate Division</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>County</span><span style='font-size:7.5pt;font-family:"Times","serif"'> of_______________</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>____________Judicial Court</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>State of South Dakota (Plaintiff)</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>vs</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>___________________________________</span></p> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>(Defendant)</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>No. _____________HP</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>THE UNDERSIGNED PEACE OFFICER COMPLAINS AND STATES THAT</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>ON OR ABOUT</span></p> </td> <td width=211 colspan=18 valign=top style='width:158.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>AT OR NEAR (LOCATION/MILE POST)</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>AT TIME</span></p> </td> </tr> <tr> <td width=319 colspan=22 valign=top style='width:239.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>A.M.</span></p> </td> </tr> <tr> <td width=319 colspan=22 valign=top style='width:239.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>P.M.</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_________________</span></p> </td> <td width=211 colspan=18 valign=top style='width:158.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>____________________________________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>________</span></p> </td> </tr> <tr> <td width=319 colspan=22 valign=top style='width:239.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>WITHIN THE COUNTY AND STATE AFORESAID</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>NAME</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>HEIGHT</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>SEX</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____________________________</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>_____</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>ADDRESS</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>WEIGHT</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____________________________</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>CITY</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>STATE</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>BIRTH DATE</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____________________________</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>____________</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>DRIVER'S LICENSE NO.</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>STATE</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____________________________</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=84 colspan=3 valign=top style='width:62.9pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>DID UNLAWFULLY</span></p> </td> <td width=83 colspan=3 valign=top style='width:62.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>OPERATE</span></p> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>_________</span></p> </td> <td width=52 colspan=8 valign=top style='width:39.3pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>PARK</span></p> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>______</span></p> </td> <td width=100 colspan=8 valign=top style='width:74.8pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>VEHICLE MAKE</span></p> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>_______________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>BODY STYLE</span></p> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>_____________</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>STATE LICENSE NO.</span></p> </td> <td width=77 colspan=10 valign=top style='width:58.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>YEAR</span></p> </td> <td width=75 colspan=6 valign=top style='width:56.1pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>STATE</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>FR______Y</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____________________________</span></p> </td> <td width=76 colspan=9 valign=top style='width:57.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>______</span></p> </td> <td width=76 colspan=7 valign=top style='width:57.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>_______</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>______N</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>AND THEN AND THERE COMMIT THE FOLLOWING OFFENSE TO WIT:</span></p> </td> </tr> <tr> <td width=194 colspan=10 valign=top style='width:145.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>PETTY OFF _____</span></p> </td> <td width=75 colspan=7 valign=top style='width:56.1pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>MIS ______</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>DESCRIBE VIOLATION:</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_________________________________________________</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>CDL ____Y____N</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>C Veh.____Y____N____E</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_________________________________________________</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>Haz. Materials ____Y____N</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>in violation of SDCL_________________________________</span></p> </td> </tr> <tr> <td width=187 colspan=9 valign=top style='width:1.95in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=228 colspan=15 valign=top style='width:171.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=82 colspan=2 valign=top style='width:61.5pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=105 colspan=7 valign=top style='width:78.9pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____Municipal</span></p> </td> <td width=228 colspan=15 valign=top style='width:171.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=82 colspan=2 valign=top style='width:61.5pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>SPEEDING</span></p> </td> <td width=105 colspan=7 valign=top style='width:78.9pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____Interstate</span></p> </td> <td width=228 colspan=15 valign=top style='width:171.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=82 colspan=2 valign=top style='width:61.5pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=105 colspan=7 valign=top style='width:78.9pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____Other</span></p> </td> <td width=94 colspan=10 valign=top style='width:70.7pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>______M.P.H. IN</span></p> </td> <td width=134 colspan=5 valign=top style='width:100.3pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>______M.P.H. ZONE</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=157 colspan=5 valign=top style='width:117.6pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>OFFICER ISSUING SUMMONS</span></p> </td> <td width=50 colspan=8 valign=top style='width:37.4pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>NO.</span></p> </td> <td width=87 colspan=7 valign=top style='width:65.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>CITY</span></p> </td> <td width=62 colspan=3 valign=top style='width:46.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>COUNTY</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>STATE</span></p> </td> </tr> <tr> <td width=157 colspan=5 valign=top style='width:117.6pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>___________________________</span></p> </td> <td width=50 colspan=8 valign=top style='width:37.4pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____</span></p> </td> <td width=87 colspan=7 valign=top style='width:65.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>______________</span></p> </td> <td width=62 colspan=3 valign=top style='width:46.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_________</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-top:0in;margin-right:0in; margin-bottom:0in;margin-left:-267.2pt;margin-bottom:.0001pt;text-align:right; line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_______</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>ABOVE COMPLAINT IS TRUE AS I VERILY BELIEVE</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>DATE</span></p> </td> </tr> <tr style='height:14.15pt'> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:14.15pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>OFFICER SIGN IN PRESENCE OF COURT OR NOTARY</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt; height:14.15pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>__________________________________________________________________</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>_______</span></p> </td> </tr> <tr> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:.2in'> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:.2in'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>SUBSCRIBED AND SWORN TO ME THIS DATE (NAME AND TITLE)</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt; height:.2in'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>DATE</span></p> </td> </tr> <tr> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>__________________________________________________________________</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>_______</span></p> </td> </tr> <tr> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><b><span style='font-size:9.0pt; font-family:"Times","serif"'>SUMMONS and PROMISE TO APPEAR</span></b></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>Defendant is ordered and does promise to appear in the above Court located in the city of</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=178 colspan=7 valign=top style='width:133.6pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_______________________________</span></p> </td> <td width=41 colspan=7 valign=top style='width:30.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>on</span></p> </td> <td width=196 colspan=10 valign=top style='width:147.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>________________________________&nbsp; at</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=70 valign=top style='width:52.15pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>a.m.</span></p> </td> <td width=346 colspan=23 valign=top style='width:259.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=70 valign=top style='width:52.15pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>p.m.</span></p> </td> <td width=346 colspan=23 valign=top style='width:259.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=70 valign=top style='width:52.15pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_______</span></p> </td> <td width=346 colspan=23 valign=top style='width:259.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=70 valign=top style='width:52.15pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> <td width=346 colspan=23 valign=top style='width:259.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>X ____________________________________________________________________________ </span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>Defendant's signature</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>(Signing this form is a promise to appear - not an admission of guilt. Violation of promise to</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>appear is a Class 2 misdemeanor, and a warrant may be issued.)</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=307 colspan=20 valign=top style='width:3.2in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____Yes _____No</span></p> </td> <td width=307 colspan=20 valign=top style='width:3.2in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>Court appearance required.</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____Yes _____No</span></p> </td> <td width=307 colspan=20 valign=top style='width:3.2in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>Power of attorney in lieu of appearance.&nbsp; Amount $______________</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=307 colspan=20 valign=top style='width:3.2in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=307 colspan=20 valign=top style='width:3.2in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>(2) <u>Form B</u>:</span></p> </td> <td width=307 colspan=20 valign=top style='width:3.2in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=307 colspan=20 valign=top style='width:3.2in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><b><span style='font-size:9.0pt; font-family:"Times","serif"'>UNIFORM TRAFFIC TICKET</span></b></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><b><span style='font-size:9.0pt; font-family:"Times","serif"'>SUMMONS-COMPLAINT</span></b></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:8.0pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>State of South Dakota </span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>In Circuit Court</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>Magistrate Division</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>County</span><span style='font-size:7.5pt;font-family:"Times","serif"'> of_______________</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>____________Judicial Court</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>State of South Dakota (Plaintiff)</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>vs</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=195 colspan=11 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>___________________________________</span></p> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>(Defendant)</span></p> </td> <td width=220 colspan=13 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>THE UNDERSIGNED PEACE OFFICER COMPLAINS AND STATES THAT</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>ON OR ABOUT</span></p> </td> <td width=211 colspan=18 valign=top style='width:158.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>AT OR NEAR (LOCATION/MILE POST)</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>AT TIME</span></p> </td> </tr> <tr> <td width=319 colspan=22 valign=top style='width:239.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>A.M.</span></p> </td> </tr> <tr> <td width=319 colspan=22 valign=top style='width:239.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>P.M.</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_________________</span></p> </td> <td width=211 colspan=18 valign=top style='width:158.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>____________________________________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>________</span></p> </td> </tr> <tr> <td width=319 colspan=22 valign=top style='width:239.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>WITHIN THE COUNTY AND STATE AFORESAID</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>NAME</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>HEIGHT</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>SEX</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____________________________</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>_____</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>ADDRESS</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>WEIGHT</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____________________________</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>CITY</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>STATE</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>BIRTH DATE</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____________________________</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>____________</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>DRIVER'S LICENSE NO.</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>STATE</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____________________________</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=84 colspan=3 valign=top style='width:62.9pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>DID UNLAWFULLY</span></p> </td> <td width=83 colspan=3 valign=top style='width:62.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>OPERATE</span></p> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>_________</span></p> </td> <td width=52 colspan=8 valign=top style='width:39.3pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>PARK</span></p> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>______</span></p> </td> <td width=100 colspan=8 valign=top style='width:74.8pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>VEHICLE MAKE</span></p> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>_______________</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>BODY STYLE</span></p> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>_____________</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>STATE LICENSE NO.</span></p> </td> <td width=77 colspan=10 valign=top style='width:58.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>YEAR</span></p> </td> <td width=75 colspan=6 valign=top style='width:56.1pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>STATE</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>FR______Y</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____________________________</span></p> </td> <td width=76 colspan=9 valign=top style='width:57.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>______</span></p> </td> <td width=76 colspan=7 valign=top style='width:57.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>_______</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>______N</span></p> </td> </tr> <tr> <td width=167 colspan=6 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=152 colspan=16 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=96 colspan=2 valign=top style='width:72.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>AND THEN AND THERE COMMIT THE FOLLOWING OFFENSE TO WIT:</span></p> </td> </tr> <tr> <td width=194 colspan=10 valign=top style='width:145.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>PETTY OFF _____</span></p> </td> <td width=75 colspan=7 valign=top style='width:56.1pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>MIS ______</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>DESCRIBE VIOLATION:</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_________________________________________________</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>CDL ____Y____N</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>C Veh.____Y____N____E</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_________________________________________________</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>Haz. Materials ____Y____N</span></p> </td> </tr> <tr> <td width=269 colspan=17 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=146 colspan=7 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>in violation of SDCL_________________________________</span></p> </td> </tr> <tr> <td width=182 colspan=8 valign=top style='width:136.3pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=233 colspan=16 valign=top style='width:175.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=82 colspan=2 valign=top style='width:61.5pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=100 colspan=6 valign=top style='width:74.8pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____Municipal</span></p> </td> <td width=233 colspan=16 valign=top style='width:175.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=82 colspan=2 valign=top style='width:61.5pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>SPEEDING</span></p> </td> <td width=100 colspan=6 valign=top style='width:74.8pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____Interstate</span></p> </td> <td width=233 colspan=16 valign=top style='width:175.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=82 colspan=2 valign=top style='width:61.5pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=100 colspan=6 valign=top style='width:74.8pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____Other</span></p> </td> <td width=88 colspan=10 valign=top style='width:66.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>______M.P.H. IN</span></p> </td> <td width=145 colspan=6 valign=top style='width:108.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>______M.P.H. ZONE</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=157 colspan=5 valign=top style='width:117.6pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>OFFICER ISSUING SUMMONS</span></p> </td> <td width=50 colspan=8 valign=top style='width:37.4pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>NO.</span></p> </td> <td width=88 colspan=8 valign=top style='width:66.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>CITY</span></p> </td> <td width=61 colspan=2 valign=top style='width:46.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>COUNTY</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>STATE</span></p> </td> </tr> <tr> <td width=157 colspan=5 valign=top style='width:117.6pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>___________________________</span></p> </td> <td width=50 colspan=8 valign=top style='width:37.4pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____</span></p> </td> <td width=88 colspan=8 valign=top style='width:66.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>______________</span></p> </td> <td width=61 colspan=2 valign=top style='width:46.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_________</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-top:0in;margin-right:0in; margin-bottom:0in;margin-left:-267.2pt;margin-bottom:.0001pt;text-align:right; line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_______</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>ABOVE COMPLAINT IS TRUE AS I VERILY BELIEVE</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>DATE</span></p> </td> </tr> <tr style='height:7.0pt'> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:7.0pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>OFFICER SIGN IN PRESENCE OF COURT OR NOTARY</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt; height:7.0pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>__________________________________________________________________</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>_______</span></p> </td> </tr> <tr> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr style='height:.2in'> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt;height:.2in'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>SUBSCRIBED AND SWORN TO ME THIS DATE (NAME AND TITLE)</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt; height:.2in'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>DATE</span></p> </td> </tr> <tr> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>__________________________________________________________________</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>_______</span></p> </td> </tr> <tr> <td width=356 colspan=23 valign=top style='width:267.2pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=59 valign=top style='width:44.2pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><b><span style='font-size:9.0pt; font-family:"Times","serif"'>SUMMONS and PROMISE TO APPEAR</span></b></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>Defendant is ordered and does promise to appear in the above Court located in the city of</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=178 colspan=7 valign=top style='width:133.6pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_______________________________</span></p> </td> <td width=27 colspan=5 valign=top style='width:20.3pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>on</span></p> </td> <td width=210 colspan=12 valign=top style='width:157.5pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>___________________________________&nbsp; at</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=70 valign=top style='width:52.15pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>a.m.</span></p> </td> <td width=346 colspan=23 valign=top style='width:259.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=70 valign=top style='width:52.15pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>p.m.</span></p> </td> <td width=346 colspan=23 valign=top style='width:259.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=70 valign=top style='width:52.15pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_______</span></p> </td> <td width=346 colspan=23 valign=top style='width:259.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=70 valign=top style='width:52.15pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=346 colspan=23 valign=top style='width:259.25pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='margin-bottom:0in;margin-bottom:.0001pt; text-align:right;line-height:normal'><span style='font-size:7.5pt;font-family: "Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>X ____________________________________________________________________________ </span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>Defendant's signature</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>(Signing this form is a promise to appear - not an admission of guilt. Violation of promise to</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='margin-bottom:0in;margin-bottom:.0001pt; text-align:center;line-height:normal'><span style='font-size:7.5pt; font-family:"Times","serif"'>appear is a Class 2 misdemeanor, and a warrant may be issued.)</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> <td width=307 colspan=20 valign=top style='width:3.2in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____Yes _____No</span></p> </td> <td width=307 colspan=20 valign=top style='width:3.2in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>Court appearance required.</span></p> </td> </tr> <tr> <td width=108 colspan=4 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>_____Yes _____No</span></p> </td> <td width=307 colspan=20 valign=top style='width:3.2in;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>Power of attorney in lieu of appearance.&nbsp; Amount $________________</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;line-height: normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><u><span style='font-size:7.5pt;font-family:"Times","serif"'>PETTY OFFENSES</span></u><span style='font-size:7.5pt;font-family:"Times","serif"'>:&nbsp; If charged with&nbsp; a petty offense involving&nbsp; the operation and use of a motor</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>vehicle and you&nbsp; possess or have proof of&nbsp; a valid&nbsp; South Dakota driver's license,&nbsp; you may choose</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>alternatives&nbsp; 1, 2 or 3 below.&nbsp; If unable to meet the&nbsp; license requirement or if&nbsp; charged&nbsp; with a non-</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>traffic offense, you may choose alternate 2 or 3 below. Upon refusal of the following&nbsp; alternatives</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>you will be taken immediately to a magistrate for hearing.</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>1. <u>Promise to Appear. </u>&nbsp;You may&nbsp; sign the complaint&nbsp; as a written&nbsp; promise to&nbsp; appear.&nbsp;&nbsp; Intentional</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>failure to appear is a Class 2 misdemeanor</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>2. <u>Admission and Deposit. </u>&nbsp;You may&nbsp; sign a stipulation admitting the allegations in the complaint</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>which, together with the required deposit, will be filed with the clerk of courts.</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>3. <u>Deposit.</u>&nbsp; You may&nbsp; immediately mail said deposit&nbsp; to the clerk of courts or personally make the</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>deposit,&nbsp; either alternative to be in&nbsp; the presence of the officer.&nbsp; Refer to schedule of petty offenses</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>for amount required for the deposit.</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>&nbsp;</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>If you&nbsp; choose&nbsp; alternative 2 or 3&nbsp; and do not&nbsp; appear in court&nbsp; on the date specified,&nbsp; the clerk&nbsp; will</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>enter&nbsp; judgment&nbsp; against you&nbsp; and you will&nbsp; forfeit&nbsp; your&nbsp; deposit.&nbsp; You&nbsp; may&nbsp; appear in court&nbsp; after</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>signing&nbsp; an admission and&nbsp; the court may,&nbsp; upon&nbsp; motion,&nbsp; relieve you&nbsp; from the stipulation and the</span></p> </td> </tr> <tr> <td width=415 colspan=24 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:7.5pt;font-family:"Times","serif"'>effects thereof.</span></p> </td> </tr> <tr height=0> <td width=70 style='border:none'></td> <td width=12 style='border:none'></td> <td width=2 style='border:none'></td> <td width=24 style='border:none'></td> <td width=49 style='border:none'></td> <td width=10 style='border:none'></td> <td width=11 style='border:none'></td> <td width=4 style='border:none'></td> <td width=5 style='border:none'></td> <td width=7 style='border:none'></td> <td width=1 style='border:none'></td> <td width=10 style='border:none'></td> <td width=1 style='border:none'></td> <td width=12 style='border:none'></td> <td width=24 style='border:none'></td> <td width=1 style='border:none'></td> <td width=25 style='border:none'></td> <td width=1 style='border:none'></td> <td width=12 style='border:none'></td> <td width=12 style='border:none'></td> <td width=1 style='border:none'></td> <td width=24 style='border:none'></td> <td width=37 style='border:none'></td> <td width=59 style='border:none'></td> </tr> </table> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 4 SDR 64, effective March 26, 1978; 27 SDR 53, effective December 4, 2000; 41 SDR 218, effective July 1, 2015.</span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><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">23-1A-2.</A></span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><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">23-1A-2</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=23-1A-5">23-1A-5.</A></span></p> <p class=MsoNormal style='margin-bottom:0in;margin-bottom:.0001pt;text-align: justify;line-height:normal'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;</span></p> </div> </body> </html>