SD EForm - 1648 V1 South Dakota Department of Labor and Regulation Division of Labor and Management , Petitioners, and , Respondent. * * * * * * * * * I. The name of the employer, employer's contact person, address and phone number is: PETITION FOR DECERTIFICATION II. The name of the employee organization, contact person, address and phone number is: III. The employee organization was certified by the Division of Labor and Management on : IV. The unit of employees is defined as follows: V. The Number of employees in the unit is: VI. The reason for requesting decertification is: Dated this day of , . ____________________________________ (Petitioner) DOL-LM-10-00 American LegalNet, Inc. www.FormsWorkFlow.com