STATE OF SOUTH DAKOTA COUNTY OF _______________ ) :SS ) IN CIRCUIT COURT ________ JUDICIAL CIRCUIT In the Matter of the Petition regarding _______________________________ (Birth Certificate Name), A Minor Child. For a Change of Name to _______________________________ (Proposed Name). CIV. _______ NOTICE & ADMISSION OF SERVICE OF VERIFIED PETITION FOR NAME CHANGE OF A MINOR CHILD (UNCONTESTED) & NOTICE OF HEARING (BY MAIL) TO ___________________________________, THE NON-PETITIONING PARENT: The enclosed single copies of a Verified Petition for Name Change of a Minor Child (Uncontested) and a Notice of Hearing for Name Change of a Minor Child (Uncontested) are sent to you pursuant to SDCL § 15-6-4(i), as well as two (2) copies of this Notice & Admission of Service of Verified Petition for Name Change of a Minor Child (Uncontested) & Notice of Hearing, and a return envelope, postage prepaid, addressed to the Plaintiff. You must complete the Admission of Service portion of this form and return the original to the sender within 20 days. In completing the form, you must fill in the town and state where you received the papers and sign and date the document. Failure to sign and return the original Admission of Service within 20 days after the date of mailing without good cause will result in the Court ordering the person so served to pay the costs of personal service. SDCL 15-6-4(i). After you complete and return this form, you may then answer (respond to) the verified petition within 30 more days. If you choose not to answer in time, an Order for Name Change of a Minor Child pursuant to the verified petition may be entered by the court. I hereby certify that this Notice & Admission of Service was mailed, postage prepaid, on this ________ day of ___________________________, 20__________ to the above-named Non-Petitioning Parent, _________________________________________, at the following Page 1 of 4 Form UJS-032A Rev. 07/2015 American LegalNet, Inc. www.FormsWorkFlow.com mailing address: ______________________________________ ______________________________________ from ___________________________________ (city where documents were mailed from), _____________________________ County, _________________________________________ (state where documents were mailed from). Dated this _______ day of ____________________________, 20______. _________________________________________ Petitioner's Signature _________________________________________ Printed or typed name _________________________________________ Mailing Address _________________________________________ City, State and Zip Code __________________________________________ Telephone Number Page 2 of 4 Form UJS-032A Rev. 07/2015 American LegalNet, Inc. www.FormsWorkFlow.com ADMISSION OF SERVICE OF VERIFIED PETITION FOR NAME CHANGE OF A MINOR CHILD (UNCONTESTED) AND NOTICE OF HEARING FOR NAME CHANGE OF A MINOR CHILD (UNCONTESTED) I, __________________________________________, admit receiving a copy of the Verified Petition for Name Change of a Minor Child (Uncontested) and a copy of the 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; it does not admit or deny any of the statements contained in those papers. Dated this ________day of ________________________, 20_____. _________________________________________ Signature of Non-Petitioning Parent _________________________________________ Typed or Printed Name _________________________________________ Mailing Address _________________________________________ City, State and Zip Code _________________________________________ Telephone Number Sworn/affirmed before me this _______ day of ____________, 20___. _______________________________ (Notary Public/Clerk of Court) _______________________________ If notary, my commission expires (SEAL) Page 3 of 4 Form UJS-032A Rev. 07/2015 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF SOUTH DAKOTA COUNTY OF _______________ ) :SS ) IN CIRCUIT COURT ________ JUDICIAL CIRCUIT In the Matter of the Petition regarding _______________________________ (Birth Certificate Name), A Minor Child. CIV. _______ AFFIDAVIT OF MAILING For a Change of Name to _______________________________ (Proposed Name). I, ________________________________________________, being sworn, state that on (Full legal name of Petitioning Parent) ____________________________________________, 20____, I sent the following documents: 2 copies of the Notice & Admission of Service of Verified Petition for Name Change of a Minor (Uncontested) & Notice of Hearing, 1 copy of the Verified Petition for Name Change of a Minor (Uncontested), and 1 copy of the Notice of Hearing for a Name Change of a Minor Child (Uncontested) by placing true and correct copies in an envelope addressed to: _________________________________ at __________________________________________ (Full legal name of Non-Petitioning Parent) (Non-Petitioning Parent's mailing address) in the City of _____________________________, State of _____________________________, Zip Code ___________ and depositing the envelope, with sufficient postage, in the United States Mail at _____________________________________________________. (city and state mailed from) Dated this _______ day of __________________________, 20________. ____________________________________ Signature of 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) Name: (Printed)_______________________ Address:____________________________ City/State/Zip:________________________ Telephone: (____)_____________________ Form UJS-032A Rev. 07/2015 American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 4