STATE OF SOUTH DAKOTA COUNTY OF ____________________ ) ) ) IN CIRCUIT COURT ______________ JUDICIAL CIRCUIT ________________________________, Petitioner -vs________________________________, Respondent TO THE PARTIES: TPO NO: ___________________________ NOTICE OF HEARING AND SUMMONS TO APPEAR (DOMESTIC ABUSE) YOU ARE NOTIFIED that a Petition and Affidavit has been filed with this Court seeking a Protection Order against you according to the provisions of the South Dakota Protection from Domestic Abuse Act, SDCL ch. 25-10. A copy of the Petition and Affidavit together with a copy of an Ex Parte Temporary Order of Protection, if one has been issued, is attached to this summons and is served upon you. Temporary Order of Protection denied. Hearing only. There will be a hearing on the Petitioner's Petition on the _____ day of ___________________, 20_____, at ________ __.M., in the _________________ County Courthouse, in __________________ (courtroom), in ________________________, South Dakota. IF YOU FAIL TO APPEAR AT THE HEARING AND ANSWER THE PETITION, AN ORDER OF PROTECTION MAY BE ENTERED AGAINST YOU AS REQUESTED. Service of this notice is authorized on any day including Sunday. DATED: _______________________________ Judge Attest_______________________, Clerk of Courts by___________________, Deputy ACKNOWLEDGMENT OF PERSONAL SERVICE I acknowledge receipt of a copy of this Notice of Hearing. Petitioner Date Respondent Date UNDER A PERMANENT PROTECTION ORDER: You may be subject to the following federal laws: (1) Effective immediately, you may not possess, carry, ship or transport any firearm or ammunition that has been transported in interstate or foreign commerce while this Protection Order is in effect. Title 18 United States Code Section 922(g)(8). (2) If you violate this Protection Order and are convicted of an offense of domestic violence, you may be forbidden for life from possessing, carrying, shipping or transporting, any firearm or ammunition that has been transported in interstate or foreign commerce. Title 18 United States Code Section 922(g)(9). Violation of these federal laws carries a maximum penalty of ten years in prison, a $250,000 fine, or both. Form UJS-091B (Domestic Notice of Hearing) Rev. 07/14 American LegalNet, Inc. www.FormsWorkFlow.com