STATE OF SOUTH DAKOTA ) :SS ) IN CIRCUIT COURT COUNTY OF _______________ ________ JUDICIAL CIRCUIT In the Matter of the Petition regarding _______________________________ (Birth Certificate Name), A Minor Child. For a Change of Name to _______________________________ (Proposed Name). CIV. _______ ADMISSION OF SERVICE OF VERIFIED PETITION FOR NAME CHANGE OF A MINOR CHILD (UNCONTESTED) & NOTICE OF HEARING (BY HAND DELIVERY) I, ____________________________________________________, the Non-Petitioning Parent of the above-named Minor Child, admit receiving copies of the Verified Petition for Name Change of a Minor Child (Uncontested) and Notice of Hearing for Name Change of a Minor Child (Uncontested) in the above-captioned matter at: _________________________________________________ (city) _________________________________________________ (county) _________________________________________________ (state). This Admission merely acknowledges receipt of the papers; I do not admit or deny any of the statements contained in those papers. Dated this ________ day of ______________________, 20_______. ____________________________________ Signature of Non-Petitioning Parent (Sign only in front of a notary or Clerk of Court) Sworn/affirmed before me this _______ day of ____________, 20___. _______________________________ (Notary Public/Clerk of Court) _______________________________ If notary, my commission expires (SEAL) Print Name of Parent: __________________________ Address:_____________________________________ City/State/Zip:________________________________ Telephone: (____)_____________________________ American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 1 Form UJS-032B Rev. 07/2015