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STATE OF SOUTH DAKOTA COUNTY OF ______________

__________________________ Plaintiff, v. __________________________ Defendant.

) IN CIRCUIT COURT )SS. ) __________ JUDICIAL CIRCUIT ) Civ. No. _________ ) ) ) PETITION FOR ORDER ) IMPLEMENTING SOUTH DAKOTA ) PARENTING TIME GUIDELINES ) ) )

COMES NOW, __________________________, (person filing Petition) and petitions this Court for an order to include the South Dakota Parenting Time Guidelines into their prior visitation/custody/child support (circle one) court order previously ordered by the Court regarding my minor child(ren). In support of my request I state as follows: 1. That I am the Plaintiff/Defendant (circle one) in the above-entitled action which was an

action for visitation/custody/child support. (circle one) 2. 3. ______ I have attached a copy of the prior Court Order to this Petition. Child(ren)'s name (list all involved minor children) DOB ________________ DOB ________________ DOB ________________

1. __________________________________________ 2. __________________________________________ 3. __________________________________________ 4.

Current address of minor child(ren): __________________________________________ State: _________________ Zip: ______________

Form UJS-261 Rev. 10/2008

5.

The addresses of minor child(ren) for the past five years: (attach additional pages if necessary): ____________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

6.

Names and addresses of all persons with whom the child(ren) has lived during the past five years: _______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

7.

I have/have not (circle one) participated in any capacity in any other legal proceeding that concerns the custody or visitation with the child? If so please explain: _______________________________________________________ ________________________________________________________________________

8.

I know/do not know (circle one) of any proceeding (Protection Order, adoption, termination of parental rights, etc) which could effect this proceeding? If so please explain: _______________________________________________________ ________________________________________________________________________

9.

Names and addresses of any person not a party to this proceeding who has the physical custody of the child or claims rights to the legal and/or physical custody of or visitation with the child. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Form UJS-261 Rev. 10/2008

10.

I have provided Notice, a copy of this Petition and the South Dakota Parenting Time Guidelines to the responding parent.

11.

_______ I have attached a copy of the Petition, Notice of Petition and proposed Order to this petition.

12.

______ I have attached Proof of Service to this Petition OR, _______ I have attached a signed Admission of Service from the other party. (Check one) THEREFORE, I ask the Court that if the opposing party objects to the implementation

of the standard guidelines within ten days of Service, the Court will set an expedited hearing on the matter. If the opposing party files an Objection to the Petition, the Clerk will send separate Notice of hearing to both parties. If the opposing party does not object within ten days I ask the Court to enter an Order to implement the South Dakota Parenting Time Guidelines. I further request whatever other relief the Court believes justified. My current address is: _____________________________________________________ State _______________________ Zip Code ______________________. The Plaintiff/Defendant's (circle one) current address is: __________________________ State _______________________ Zip Code _______________________.

Dated this _______ day of ________________, 20___.

______________________________________________ Signature (person filing Petition)

Form UJS-261 Rev. 10/2008

State of South Dakota

) )ss. County of ______________ )

On this _______ day of ________________, 20___, I swear under oath that the allegations set forth in this Verified Petition are true and correct to the best of my knowledge, and that I believe that I am entitled to the relief requested for, and that this legal action is not filed for harassment, abuse of process, or delay. ______________________________________________ Signature (person filing Petition)

Signed and sworn to before me this _______ day of _________________, 20___.

(SEAL)

______________________________________________ Notary Public Commission Expires:

Form UJS-261 Rev. 10/2008