STATE OF SOUTH DAKOTA COUNTY OF __________________ ) ) ) IN CIRCUIT COURT _______ JUDICIAL CIRCUIT _____________________________, Petitioner -vs_____________________________, Respondent TPO NO. ______________________ NOTICE OF HEARING ON MOTION TO MODIFY AND SUMMONS TO APPEAR (DOMESTIC ABUSE) TO THE PARTIES: YOU ARE NOTIFIED that a Motion to Modify has been filed with this Court seeking a modification of the permanent protection order filed against you, according to the provisions of the South Dakota Protection from Stalking Act, SDCL ch. 22-19A; and/or from Physical Injury, SDCL 22-1-2(9). A copy of the Motion to Modify is attached to this Summons and is served upon you. There will be a hearing on the Petitioner's Motion 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 MOTION, THE ORDER OF PROTECTION MAY BE MODIFIED AS REQUESTED. DATED: ____________________________ Service of this notice is authorized on any day including Sunday. Judge Attest:___________________, Clerk of Courts by: _____________________, Deputy Form UJS-091H (Domestic Notice of Hearing to Modify Permanent) Rev. 07/14 American LegalNet, Inc. www.FormsWorkFlow.com 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-091H (Domestic Notice of Hearing to Modify Permanent) Rev. 07/14 American LegalNet, Inc. www.FormsWorkFlow.com