<html xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 02:03:01:03 Power of attorney form.</title> <META NAME="Keywords" Content="Administrative Rules 02:03:01:03"> <META NAME="Description" Content="Administrative Rules 02:03:01:03 Power of attorney form."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="0203010000300D_files/filelist.xml"> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr13879</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>11</o:TotalTime> <o:LastPrinted>2007-11-30T19:34:00Z</o:LastPrinted> <o:Created>2007-11-30T20:08:00Z</o:Created> <o:LastSaved>2007-11-30T20:08:00Z</o:LastSaved> <o:Pages>2</o:Pages> <o:Words>477</o:Words> <o:Characters>2721</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>22</o:Lines> <o:Paragraphs>6</o:Paragraphs> <o:CharactersWithSpaces>3192</o:CharactersWithSpaces> <o:Version>10.6830</o:Version> </o:DocumentProperties> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:GrammarState>Clean</w:GrammarState> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:UseMarginsForDrawingGridOrigin/> <w:Compatibility> <w:FootnoteLayoutLikeWW8/> <w:ShapeLayoutLikeWW8/> <w:AlignTablesRowByRow/> <w:ForgetLastTabAlignment/> <w:LayoutRawTableWidth/> <w:LayoutTableRowsApart/> <w:UseWord97LineBreakingRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--> <style> <!-- /* Font Definitions */ @font-face {font-family:Times; 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mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; border:solid windowtext 1.0pt; mso-border-alt:solid windowtext .5pt; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-border-insideh:.5pt solid windowtext; mso-border-insidev:.5pt solid windowtext; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman";} </style> <![endif]--> </head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>2:03:01:03.<span class=GramE>&nbsp;&nbsp;Power</span> of attorney form.</b> The following form, or any other form that substantially complies with it, shall be used for offenses included on the schedule of offenses adopted pursuant to SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=16-2-21">16-2-21</A> and where a power of attorney option is provided:<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <table class=MsoTableGrid border=1 cellspacing=0 cellpadding=0 style='border-collapse:collapse;border:none;mso-border-alt:solid windowtext .5pt; mso-yfti-tbllook:480;mso-padding-alt:0in 5.4pt 0in 5.4pt;mso-border-insideh: .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><b style='mso-bidi-font-weight:normal'><span style='font-size:9.0pt'>POWER OF ATTORNEY<o:p></o:p></span></b></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:8.0pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>PCN ______________<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=195 colspan=7 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>State of South Dakota<o:p></o:p></span></p> </td> <td width=220 colspan=11 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'>In Circuit Court<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=195 colspan=7 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=220 colspan=11 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'>Magistrate Division<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=195 colspan=7 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>County of_______________<o:p></o:p></span></p> </td> <td width=220 colspan=11 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'>____________Judicial Court<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=195 colspan=7 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=220 colspan=11 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=195 colspan=7 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>State of South Dakota (Plaintiff)<o:p></o:p></span></p> </td> <td width=220 colspan=11 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=195 colspan=7 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=220 colspan=11 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=195 colspan=7 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>Vs<o:p></o:p></span></p> </td> <td width=220 colspan=11 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=195 colspan=7 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=220 colspan=11 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=195 colspan=7 valign=top style='width:146.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>___________________________________<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>(Defendant)<o:p></o:p></span></p> </td> <td width=220 colspan=11 valign=top style='width:164.95pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'>No. _____________HP<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>THE UNDERSIGNED PEACE OFFICER COMPLAINS AND STATES THAT<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=108 colspan=3 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>ON OR ABOUT<o:p></o:p></span></p> </td> <td width=211 colspan=13 valign=top style='width:158.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>AT OR NEAR (LOCATION/MILE POST)<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>AT TIME<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=319 colspan=16 valign=top style='width:239.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></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='text-align:right'><span style='font-size:7.5pt'>A.M.<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=319 colspan=16 valign=top style='width:239.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></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='text-align:right'><span style='font-size:7.5pt'>P.M.<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=108 colspan=3 valign=top style='width:81.0pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_________________<o:p></o:p></span></p> </td> <td width=211 colspan=13 valign=top style='width:158.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>____________________________________<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>________<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=319 colspan=16 valign=top style='width:239.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>WITHIN THE COUNTY AND STATE AFORESAID<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>NAME<o:p></o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>HEIGHT<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>SEX<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_____________________________<o:p></o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>________<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>_____<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>ADDRESS<o:p></o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>WEIGHT<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_____________________________<o:p></o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>________<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>CITY<o:p></o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>STATE<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>BIRTH DATE<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_____________________________<o:p></o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>________<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>____________<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>DRIVER'S LICENSE NO.<o:p></o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>STATE<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_____________________________<o:p></o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>________<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=84 colspan=2 valign=top style='width:62.9pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>DID UNLAWFULLY<o:p></o:p></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='text-align:center'><span style='font-size:7.5pt'>OPERATE<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>_________<o:p></o:p></span></p> </td> <td width=52 colspan=5 valign=top style='width:39.3pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>PARK<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>______<o:p></o:p></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 align=center style='text-align:center'><span style='font-size:7.5pt'>VEHICLE MAKE<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>_______________<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>BODY STYLE<o:p></o:p></span></p> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'>_____________<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>STATE LICENSE NO.<o:p></o:p></span></p> </td> <td width=77 colspan=7 valign=top style='width:58.0pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>YEAR<o:p></o:p></span></p> </td> <td width=75 colspan=4 valign=top style='width:56.1pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>STATE<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>FR______Y<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_____________________________<o:p></o:p></span></p> </td> <td width=76 colspan=6 valign=top style='width:57.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>______<o:p></o:p></span></p> </td> <td width=76 colspan=5 valign=top style='width:57.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>_______<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>______N<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=167 colspan=5 valign=top style='width:125.05pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=152 colspan=11 valign=top style='width:114.1pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></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='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>AND THEN AND THERE COMMIT THE FOLLOWING OFFENSE TO WIT:<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=194 colspan=6 valign=top style='width:145.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>PETTY OFF _____<o:p></o:p></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><span style='font-size:7.5pt'>MIS ______<o:p></o:p></span></p> </td> <td width=146 colspan=5 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=269 colspan=13 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=146 colspan=5 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=269 colspan=13 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>DESCRIBE VIOLATION:<o:p></o:p></span></p> </td> <td width=146 colspan=5 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=269 colspan=13 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=146 colspan=5 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=269 colspan=13 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_________________________________________________<o:p></o:p></span></p> </td> <td width=146 colspan=5 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'>CDL ____Y____N<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=269 colspan=13 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=146 colspan=5 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'>C Veh.____Y____N____E<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=269 colspan=13 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_________________________________________________<o:p></o:p></span></p> </td> <td width=146 colspan=5 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'>Haz. Materials ____Y____N<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=269 colspan=13 valign=top style='width:201.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=146 colspan=5 valign=top style='width:109.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>in violation of SDCL_________________________________<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=194 colspan=6 valign=top style='width:145.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=221 colspan=12 valign=top style='width:165.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=82 valign=top style='width:61.5pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=112 colspan=5 valign=top style='width:84.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_____Municipal<o:p></o:p></span></p> </td> <td width=221 colspan=12 valign=top style='width:165.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=82 valign=top style='width:61.5pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>SPEEDING<o:p></o:p></span></p> </td> <td width=112 colspan=5 valign=top style='width:84.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_____Interstate<o:p></o:p></span></p> </td> <td width=221 colspan=12 valign=top style='width:165.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=82 valign=top style='width:61.5pt;border:none;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> <td width=112 colspan=5 valign=top style='width:84.15pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_____Other<o:p></o:p></span></p> </td> <td width=87 colspan=8 valign=top style='width:65.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>______M.P.H. IN<o:p></o:p></span></p> </td> <td width=134 colspan=4 valign=top style='width:100.3pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>______M.P.H. ZONE<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=157 colspan=4 valign=top style='width:117.6pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>OFFICER ISSUING SUMMONS<o:p></o:p></span></p> </td> <td width=50 colspan=5 valign=top style='width:37.4pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>NO.<o:p></o:p></span></p> </td> <td width=87 colspan=6 valign=top style='width:65.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>CITY<o:p></o:p></span></p> </td> <td width=62 colspan=2 valign=top style='width:46.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>COUNTY<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>STATE<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=157 colspan=4 valign=top style='width:117.6pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>___________________________<o:p></o:p></span></p> </td> <td width=50 colspan=5 valign=top style='width:37.4pt;border:none;padding: 0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_____<o:p></o:p></span></p> </td> <td width=87 colspan=6 valign=top style='width:65.45pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>______________<o:p></o:p></span></p> </td> <td width=62 colspan=2 valign=top style='width:46.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>_________<o:p></o:p></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='text-align:right'><span style='font-size:7.5pt'>_______<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><b style='mso-bidi-font-weight:normal'><span style='font-size:9.0pt'>POWER OF ATTORNEY<o:p></o:p></span></b></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>____________________________________<span style='mso-spacerun:yes'>&nbsp;&nbsp; </span>I<span style='mso-spacerun:yes'>&nbsp; </span>hereby<span style='mso-spacerun:yes'>&nbsp; </span>deposit<span style='mso-spacerun:yes'>&nbsp; </span>with<span style='mso-spacerun:yes'>&nbsp; </span>the<span style='mso-spacerun:yes'>&nbsp; </span>Clerk<span style='mso-spacerun:yes'>&nbsp; </span>of<span style='mso-spacerun:yes'>&nbsp; </span>Courts<span style='mso-spacerun:yes'>&nbsp; </span>of<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>__________________________<span style='mso-spacerun:yes'>&nbsp; </span>County, South Dakota, as a cash appearance bond, the sum of<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>$ ________________________ and understand that my initial appearance will be located in the<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span class=GramE><span style='font-size:7.5pt'>city</span></span><span style='font-size:7.5pt'> of ____________________________________.<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=right style='text-align:right'><span style='font-size:7.5pt'>a m.<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>on _____________________________________ at ________________________________ p.m.<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>If I desire to contest this matter, I will appear at the date, time, and place for my initial appearance<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>or<span style='mso-spacerun:yes'>&nbsp; </span>contact the<span style='mso-spacerun:yes'>&nbsp; </span>clerk<span style='mso-spacerun:yes'>&nbsp; </span>of<span style='mso-spacerun:yes'>&nbsp; </span>courts before<span style='mso-spacerun:yes'>&nbsp; </span>that date<span style='mso-spacerun:yes'>&nbsp; </span>and ask the<span style='mso-spacerun:yes'>&nbsp; </span>clerk to<span style='mso-spacerun:yes'>&nbsp; </span>reschedule<span style='mso-spacerun:yes'>&nbsp; </span>the date for my<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span class=GramE><span style='font-size:7.5pt'>initial</span></span><span style='font-size:7.5pt'> appearance.<span style='mso-spacerun:yes'>&nbsp; </span>If I do not appear or contact the clerk of courts within the time period, (or if<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>after the court date is set, I<span style='mso-spacerun:yes'>&nbsp; </span>fail to appear,)<span style='mso-spacerun:yes'>&nbsp; </span>I hereby plead guilty to the charge, and direct the clerk<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>to apply the money<span style='mso-spacerun:yes'>&nbsp; </span>deposited as bond<span style='mso-spacerun:yes'>&nbsp; </span>herewith<span style='mso-spacerun:yes'>&nbsp; </span>to the<span style='mso-spacerun:yes'>&nbsp; </span>payment<span style='mso-spacerun:yes'>&nbsp; </span>of<span style='mso-spacerun:yes'>&nbsp; </span>the fine<span style='mso-spacerun:yes'>&nbsp; </span>and costs assessed<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span class=GramE><span style='font-size:7.5pt'>against</span></span><span style='font-size:7.5pt'> me.<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>__________________ Cash taken by Officer - Officer signed<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>I have read this document and have been given a copy.<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>Signed<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'>____________________________________________________________________________<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=204 colspan=8 valign=top style='width:152.75pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>Defendant<o:p></o:p></span></p> </td> <td width=212 colspan=10 valign=top style='width:158.65pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal align=center style='text-align:center'><span style='font-size:7.5pt'>Date<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.5pt'><o:p>&nbsp;</o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:0;mso-yfti-lastrow:yes'> <td width=415 colspan=18 valign=top style='width:311.4pt;border:none; padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><span style='font-size:7.0pt'>THE SIGNED COPY MUST BE ENCLOSED WITH MONEY IN THE ENVELOPE <span style='mso-spacerun:yes'>&nbsp;</span>PROVIDED<o:p></o:p></span></p> </td> </tr> <![if !supportMisalignedColumns]> <tr height=0> <td width=82 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=27 style='border:none'></td> <td width=1 style='border:none'></td> <td width=8 style='border:none'></td> <td width=3 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=59 style='border:none'></td> </tr> <![endif]> </table> <p class=MsoNormal style='margin-right:206.65pt;text-align:justify;tab-stops: .4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Source:</b> 27 SDR 53, effective December 4, 2000.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=23-1A-2">23-1A-2.</A><o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>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><o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> </div> </body> </html>