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STATE OF SOUTH DAKOTA COUNTY OF ______________ __________________________ Plaintiff, v. ___________________________ Defendant.

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IN CIRCUIT COURT __________ JUDICIAL CIRCUIT Civ. No. _________ ADMISSION OF SERVICE

To: _________________________, (person receiving Notice) the enclosed Petition and Order to Show Cause is hereby served.

You must complete the admission part of this form and return one copy of the completed form to the sender within twenty days. You must sign and date the Admission. If you are served on behalf of another person and you are authorized to receive process, you must indicate under your signature your authority. If you do not complete and return the form to the sender within twenty days, you may be required to pay any expenses incurred in serving a summons in any other manner permitted by law.

I hereby certify that this Admission of Service, along with a copy of the Petition, was mailed on this _______ day of __________________, 20_____.

________________________________ Signature (person filing Petition)

__________________ Date

Form UJS-273 Rev. 10/2008

ADMISSION OF SERVICE OF PETITION

I, ______________________________, admit personal service of the Petition and Order to Show Cause by my receipt of said copies at _________________, South Dakota, on this ___ day of ____________, 20____.

________________________________ Signature (person receiving Notice)

__________________ Date

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

(SEAL)

__________________________________________ Notary Public Commission Expires:

Form UJS-273 Rev. 10/2008