<html> <head> <title>Rule 02:03:01:02 Forms for misdemeanor offense complaints and summons.</title> <META NAME="Keywords" Content="Administrative Rules 02:03:01:02"> <META NAME="Description" Content="Administrative Rules 02:03:01:02 Forms for misdemeanor 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>:02.&nbsp;&nbsp;Forms for misdemeanor offense complaints and summons.</b> The following form, or one which substantially complies with it, shall be used as a misdemeanor offense summons and complaint for traffic offenses. A power of attorney form in substantial compliance with &#167;&nbsp;2:03:01:03 shall be attached to the form. The promise to appear option may not be utilized for offenses set forth in SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=32-33-2.1">32-33-2.1</A> and <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=32-33-4">32-33-4</A>, or in contradiction to SDCL 32-33-2.</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 determinations to use the declaration option set forth in SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=23-1A-5">23-1A-5</A> and SDCL 23A-2-1, the form or one which substantially complies with it, 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> <table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 style='border-collapse:collapse'> <tr> <td width=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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=10 valign=top style='width:146.45pt;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=212 colspan=10 valign=top style='width:159.05pt;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=10 valign=top style='width:146.45pt;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=212 colspan=10 valign=top style='width:159.05pt;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=10 valign=top style='width:146.45pt;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=212 colspan=10 valign=top style='width:159.05pt;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=10 valign=top style='width:146.45pt;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=212 colspan=10 valign=top style='width:159.05pt;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=10 valign=top style='width:146.45pt;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=212 colspan=10 valign=top style='width:159.05pt;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=10 valign=top style='width:146.45pt;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=212 colspan=10 valign=top style='width:159.05pt;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=10 valign=top style='width:146.45pt;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=212 colspan=10 valign=top style='width:159.05pt;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=10 valign=top style='width:146.45pt;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=212 colspan=10 valign=top style='width:159.05pt;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=10 valign=top style='width:146.45pt;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=212 colspan=10 valign=top style='width:159.05pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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;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=14 valign=top style='width:158.15pt;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=88 colspan=2 valign=top style='width:66.35pt;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=18 valign=top style='width:239.15pt;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=88 colspan=2 valign=top style='width:66.35pt;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=18 valign=top style='width:239.15pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=14 valign=top style='width:158.15pt;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=2 valign=top style='width:66.35pt;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=18 valign=top style='width:239.15pt;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=88 colspan=2 valign=top style='width:66.35pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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;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=6 valign=top style='width:39.3pt;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=6 valign=top style='width:74.8pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=8 valign=top style='width:58.0pt;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=4 valign=top style='width:56.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=7 valign=top style='width:57.05pt;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=5 valign=top style='width:57.05pt;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=88 colspan=2 valign=top style='width:66.35pt;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;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=12 valign=top style='width:114.1pt;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=88 colspan=2 valign=top style='width:66.35pt;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=407 colspan=20 valign=top style='width:305.5pt;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=9 valign=top style='width:145.65pt;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=6 valign=top style='width:56.1pt;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=138 colspan=5 valign=top style='width:103.75pt;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=15 valign=top style='width:201.75pt;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=138 colspan=5 valign=top style='width:103.75pt;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=15 valign=top style='width:201.75pt;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=138 colspan=5 valign=top style='width:103.75pt;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=15 valign=top style='width:201.75pt;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=138 colspan=5 valign=top style='width:103.75pt;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=15 valign=top style='width:201.75pt;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=138 colspan=5 valign=top style='width:103.75pt;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=15 valign=top style='width:201.75pt;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=138 colspan=5 valign=top style='width:103.75pt;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=15 valign=top style='width:201.75pt;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=138 colspan=5 valign=top style='width:103.75pt;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=15 valign=top style='width:201.75pt;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=138 colspan=5 valign=top style='width:103.75pt;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=407 colspan=20 valign=top style='width:305.5pt;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=193 colspan=8 valign=top style='width:144.9pt;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=214 colspan=12 valign=top style='width:160.6pt;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;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=111 colspan=6 valign=top style='width:83.4pt;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=214 colspan=12 valign=top style='width:160.6pt;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;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=111 colspan=6 valign=top style='width:83.4pt;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=214 colspan=12 valign=top style='width:160.6pt;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;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=111 colspan=6 valign=top style='width:83.4pt;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=8 valign=top style='width:66.2pt;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=126 colspan=4 valign=top style='width:94.4pt;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=407 colspan=20 valign=top style='width:305.5pt;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;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=6 valign=top style='width:37.4pt;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=6 valign=top style='width:65.45pt;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=2 valign=top style='width:46.75pt;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=51 valign=top style='width:38.3pt;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;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=6 valign=top style='width:37.4pt;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=6 valign=top style='width:65.45pt;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=2 valign=top style='width:46.75pt;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=51 valign=top style='width:38.3pt;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=407 colspan=20 valign=top style='width:305.5pt;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=19 valign=top style='width:267.2pt;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=51 valign=top style='width:38.3pt;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=19 valign=top style='width:267.2pt;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=51 valign=top style='width:38.3pt;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=19 valign=top style='width:267.2pt;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=51 valign=top style='width:38.3pt;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=19 valign=top style='width:267.2pt;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=51 valign=top style='width:38.3pt;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=19 valign=top style='width:267.2pt;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=51 valign=top style='width:38.3pt;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=19 valign=top style='width:267.2pt;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=51 valign=top style='width:38.3pt;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=19 valign=top style='width:267.2pt;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=51 valign=top style='width:38.3pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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=182 colspan=7 valign=top style='width:136.3pt;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=25 colspan=4 valign=top style='width:18.7pt;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=201 colspan=9 valign=top style='width:150.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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;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=338 colspan=19 valign=top style='width:253.35pt;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;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=338 colspan=19 valign=top style='width:253.35pt;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;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=338 colspan=19 valign=top style='width:253.35pt;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;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=338 colspan=19 valign=top style='width:253.35pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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=407 colspan=20 valign=top style='width:305.5pt;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;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=299 colspan=16 valign=top style='width:224.5pt;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;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=299 colspan=16 valign=top style='width:224.5pt;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;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=299 colspan=16 valign=top style='width:224.5pt;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;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=299 colspan=16 valign=top style='width:224.5pt;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 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=15 style='border:none'></td> <td width=11 style='border:none'></td> <td width=1 style='border:none'></td> <td width=1 style='border:none'></td> <td width=11 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=12 style='border:none'></td> <td width=12 style='border:none'></td> <td width=25 style='border:none'></td> <td width=37 style='border:none'></td> <td width=51 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> 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=32-33-2">32-33-2</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=32-33-2.1">32-33-2.1</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=32-33-4">32-33-4</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=23-1A-5">23-1A-5</A>, <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=23A-2-1">23A-2-1.</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>