IN THE ________ JUDICIAL CIRCUIT COURT, _______________________, MISSOURI Judge or Division: Case Number: Full Name of Petitioner (Name, Address, Driver’s License No.): vs. Respondent (the person or entity making the needs assessment) (Name, Address): (Date File Stamp) Petition for Review of a SATOP Assessment Assignment Recommendation Pursuant to Section 302.304, 302.540, or 577.041 RSMo, I request that the court hear and determine this petition for review of the attached assignment recommendation contained in the Substance Abuse Traffic Offender assessment (SATOP Offender Referral form AA or new form A3). I object to the assignment recommendation for the following reasons: I request the following relief: ___________________________________________________________________________ ________________________________________ Date _____________________________________________ Petitioner Sheriff’s or Server’s Return of Service I certify that I served the above petition by: (check one) delivering a copy of the petition to the respondent. leaving a copy of the petition at the dwelling place or usual abode of the respondent with ______________________________________, a person of the respondent’s family over the age of 15 years. (for service on a corporation) delivering a copy of the petition to (name) ___________________________________________, (title) __________________________________at (address) __________________________________________________________________________________ (other) ____________________________________________________________________________________ Served in _________________________________ (County/City of St. Louis), MO, on _____________________ (date) at __________ (time). Sheriff’s fees (if applicable) Summons $ Non Est $ Sheriff’s Deputy Salary Supplemental Surcharge $ Mileage $ Total $ 10.00 (______ miles @ $.______ per mile) ______________________________________________ Sheriff or Server BY:______________________________________________ Deputy OSCA (7-08) CV135 1 of 2 Sections 302.304, 302.540, 577.041 RSMo American LegalNet, Inc. www.FormsWorkFlow.com Instructions to Petitioner 1. This petition for review should be filed in the Associate Division of the Circuit Court of the county in which the assignment was made. 2. Make sure to attach a copy of the “SATOP Offender Assignment” (form AA or new form A3) with this petition before filing. 3. The filing of this petition is a civil action for which you will be expected to pay a civil cost deposit at the time of filing. 4. It is best if you use the name of a service provider (i.e., the business or company) for the respondent instead of the individual who administered the test and held the personal interview with you. If you use the name of the individual, there may be times when the person no longer works for the provider and the petition cannot be served upon them. The court may dismiss the case if service cannot be made on the party listed as the respondent. 5. The court clerk will provide a copy of this petition to the sheriff or server to deliver to the respondent. 6. This does not exempt the petitioner from any condition of probation requiring completion of a Substance Abuse Traffic Offender Program (SATOP). OSCA (7-08) CV135 2 of 2 Sections 302.304, 302.540, 577.041 RSMo American LegalNet, Inc. www.FormsWorkFlow.com