Respondent Information
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Respondent Information Form. This is a South Dakota form and can be use in Protection Orders Statewide.
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Tags: Respondent Information, UJS-090C, South Dakota Statewide, Protection Orders
TPO:
Respondent Information Date:
Required Information
Name:
Last
First
Birth Date:
(MM/DD/YYYY)
Driver’s License Number:
Middle
(M=Male, F=Female, U=Unknown)
Sex:
License State:
SSN:
Present Address:
State:
Zip:
-
State:
City:
Zip:
-
Mailing Address:
City:
Race:
(A=Asian/Pacific Islander, B=Black, I=American Indian, O=Other, W=White,
Hair Color:
Eye Color:
U=Unknown)
Weight:
Height:
Distinguishing Features: ___________________________________________________________________________________
________________________________________________________________________________________________________
Phone Number
1 (
)
-
(H=Home, W=Work, C=Cell, O=Other, F=Fax)
2 (
)
-
(H=Home, W=Work, C=Cell, O=Other, F=Fax)
3 (
)
-
(H=Home, W=Work, C=Cell, O=Other, F=Fax)
Misc. Indicator:
__Martial Arts Expert
__Explosives Expert
__Known to Abuse Drugs
Medical Indicator:
__Heart Condition
__Epilepsy
__Hemophiliac
__Other
__Alcoholic
__Suicidal
__Diabetic
__Allergies
__Medication Required
Interpreter needed
Language
______________________________________________________________________
Respondent Vehicles
License Plate Number
State
Year
Make
Model
Color
1. __________________________________________________________________________________________
2. __________________________________________________________________________________________
3. __________________________________________________________________________________________
Occupation:
Place of Employment:
Work Days:
Work Hours:
Other persons at Respondent’s residence:
Other addresses or locations (hangouts) where Respondent can be found:
Location:
City:
State:
Zip:
-
City:
State:
Zip:
-
Location:
Form UJS-090C (Respondent Form) Rev. 05/08
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