STATE OF SOUTH DAKOTA COUNTY OF ______________ __________________________ Plaintiff, v. ___________________________ Defendant. ) )SS. ) ) ) ) ) ) ) ) ) IN CIRCUIT COURT __________ JUDICIAL CIRCUIT No. _________ ADMISSION OF SERVICE You must sign and date the admission part of this form in front of a notary or Clerk of Court and return completed form to the sender within twenty days. You may want to keep a copy for your records. 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. 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 Petition) __________________ Date Signed and sworn to before me this _______ day of _________________, 20___. __________________________________________ Notary Public/Clerk of Court Commission Expires: American LegalNet, Inc. www.FormsWorkFlow.com (SEAL) Form UJS-378 Rev. 09/2010