STATE OF SOUTH DAKOTA COUNTY OF ______________ ) ) ) , IN ___________ COURT ________________ JUDICIAL CIRCUIT Petitioner, -vs, Respondent. TPO NO.____________________ MOTION TO MODIFY PERMANENT PROTECTION ORDER (VULNERABLE ADULT ABUSE) the Petitioner / the Substitute Petitioner who petitioned for a Protection Order. I am the Respondent and the one against whom the Permanent Protection Order was granted. I am I am requesting that the Court change certain terms in the Permanent Order of Protection. (Describe what you would like changed in the Permanent Order of Protection.) (Please check the box that best describes you.) Describe why you want the Permanent Order of Protection changed: On this _______ day of _____________, __________, I swear or affirm under oath that the information I have provided in this Motion to Modify is true and correct to the best of my knowledge. I believe I am entitled to the modification I have requested. I am asking for this modification for valid reasons and am not attempting to harass the other party, and am not attempting to abuse or delay the court process or any other legal action. Petitioner / Substitute Petitioner / Respondent (circle one and sign only in front of Notary or Clerk) Signed and sworn to before me on this day of , . Notary Public/Deputy Clerk of Courts Commission Expires: (SEAL) Form UJS-120G (Vulnerable Adult) Motion to Modify Permanent Order Rev. 6/16 American LegalNet, Inc. www.FormsWorkFlow.com