South Dakota Codified Laws
Chapter 07A - Juvenile Court
Section 26-7A-A - APPENDIX OF FORMS

APPENDIX A. APPENDIX OF FORMS
FORM 1 NOTIFICATION OF TAKING TEMPORARY CUSTODY OF CHILD(REN)

(SDCL 26-7A-15)
STATE OF SOUTH DAKOTA IN CIRCUIT COURT SS. COUNTY OF __________ ________ JUDICIAL CIRCUIT THE PEOPLE OF THE STATE OF SOUTH (Case No. JUV. ________) DAKOTA IN THE INTERESTS OF _____________________________________ NOTIFICATION OF TAKING MINOR CHILD(REN), AND CONCERNING TEMPORARY CUSTODY ____________________________________ OF CHILD(REN) PARENTS, GUARDIAN OR CUSTODIAN.

TO: Parents, Guardian or Custodian of Above-named Child(ren), whose Last Known Address and Telephone Number are _____.
You are hereby notified that the above-named child(ren) was (were) taken into temporary custody at _____ o'clock __.m., on _____, the _____ day of _____, 20__, by _____ of _____, having address of _____, and telephone number _____. The child(ren) is (are) being placed in a temporary care facility. You and the child(ren) have the right to a temporary custody hearing to determine whether or not the child(ren) will continue to be held in temporary custody. The temporary custody hearing will be held within forty-eight (48) hours, excluding Saturdays, Sundays and Court holidays, from the time of taking temporary custody of the child(ren). The hearing may be held in the Courtroom of the Courthouse at _____, South Dakota, or telephonically, as determined by the Court. The hearing is tentatively scheduled to begin at ___ o'clock __.m. on _____, the ____ day of _____, 20__, at the Courtroom in the Courthouse in _____, _____ County, South Dakota.
You have the right to attend the temporary custody hearing and all other hearings in the action. You have the right to have an attorney represent you. If you want to be represented by an attorney, you should begin now to obtain your attorney and notify the Court of your attorney's name, address and telephone number. If you want an attorney but cannot afford to pay an attorney, you have the right to request the Court to appoint an attorney for you according to the laws of the State of South Dakota.
Issued at ___ o'clock __.m. on _____, the ____ day of _____, 20__. _____________________ (Signature of Officer)
Source: SL 1991, ch 217, § 175.

FORM 2 STATEMENT OF STATE'S ATTORNEY RE PRELIMINARY INVESTIGATION

(SDCL 26-7A-10)
STATE OF SOUTH DAKOTA IN CIRCUIT COURT SS. COUNTY OF __________ ________ JUDICIAL CIRCUIT IN THE INTEREST OF (Case No. JUV. ________) _____________________________________ MINOR CHILD(REN) STATEMENT OF STATE'S ATTORNEY RE PRELIMINARY INVESTIGATION
Undersigned _______ State's Attorney has been informed that the above-named child(ren) appear(s) to be within the purview of SDCL 26-7A and SDCL 26-8__. A preliminary investigation has been made to determine whether further action should be taken and this State's Attorney has determined as follows: __ (1) No further action is required. __ (2) The information relates to an apparent abused or neglected child and additional information is required. The matter is referred to the South Dakota Department of Social Services for further investigation and recommendations to this State's Attorney. __ (3) The information relates to [an apparent child(ren) in need of supervision] [an apparent delinquent child(ren)] and the matter is referred as follows:
__ [a] To a court services officer for informal adjustment under the supervision of the Court that is practicable without a petition being filed; or
__ [b] To a Court-approved juvenile diversion program for informal action outside the Court system without a petition being filed. __ (4) File a petition to commence appropriate proceedings.
Dated the ___ day of _____, 20__. _____________________________________ _______________________ State's Attorney __________________ County, South Dakota
Source: SL 1991, ch 217, § 176.

FORM 3 PETITION [Alleged Abused or Neglected Child(ren)]

(SDCL 26-7A-43)
STATE OF SOUTH DAKOTA IN CIRCUIT COURT SS. COUNTY OF __________ ________ JUDICIAL CIRCUIT THE PEOPLE OF THE STATE OF SOUTH (Case No. JUV. ________) DAKOTA, EX REL. SOUTH DAKOTA DEPARTMENT OF SOCIAL SERVICES, IN THE INTERESTS OF PETITION _____________________________________ [Alleged Abused Or MINOR CHILD(REN), AND CONCERNING Neglected Child(ren)] ____________________________________ RESPONDENTS. .
TO: Judge of the Circuit Court, _____ Judicial Circuit, State of South Dakota, in and for _____ County, South Dakota.
Petitioner alleges as follows:
1. The above-named child(ren) is (are) located or residing in _____ County, South Dakota, and is (are) alleged to be an abused or neglected child(ren) as defined by SDCL 26-7A and SDCL 26-8A.

2. This action is brought by the State on behalf of the South Dakota Department of Social Services.
3. The name(s), date(s) of birth and residence of the child(ren) are as follows: Name Date of Birth Residence ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
4. The names and residences of the parents, guardian or custodian of the child(ren) are as follows: Name Residence ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
5. The facts which bring the child(ren) within the Court's jurisdiction are as follows: _____. Affidavits of _____, dated _____ attached hereto, is (are) incorporated by reference as part of this Petition.
6. It is in the best interests of the child(ren) and the State that the child(ren) be adjudicated to be abused or neglected child(ren).
7. It appears the Indian Child Welfare Act (is not) (is) applicable for the following reasons: _____
WHEREFORE, Petitioner requests the Court to issue Summons requiring the appropriate parties to appear and answer to the Petition, to schedule hearing on this Petition and to conduct adjudication and dispositional proceedings according to law.
Source: SL 1991, ch 217, § 177.
FORM 4 PETITION

(SDCL 26-7A-13)

TO: Judge of the Circuit Court, _____ Judicial Circuit, State of South Dakota, in and for _____ County, South Dakota.
Petitioner alleges as follows:
1. The above-named child(ren) is (are) located or residing in _______ County, South Dakota, and is (are) alleged to be [child(ren) in need of supervision] [delinquent child(ren)], as defined by SDCL 26-7A and (SDCL 26-8B) (SDCL 26-8C).
2. The name(s), date(s) of birth and residence of the child(ren) are as follows: Name Date of Birth Residence ______________________________________________________________________________ ______________________________________________________________________________

3. The names and residences of the parents, guardian or custodian of the child(ren) are as follows: Name Residence ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
4. The facts which bring the child(ren) within the Court's jurisdiction are as follows: _____. Affidavits of _____, dated _____, attached hereto, is (are) incorporated by reference as part of this Petition.
5. It appears the Indian Child Welfare Act (is not) (is) applicable for the following reasons: _____.
WHEREFORE, Petitioner requests the Court to issue Summons requiring the appropriate parties to appear and answer to the Petition, to schedule hearing on this Petition and to conduct adjudication and dispositional proceedings according to law.
IN INTERESTS OF PETITION ______________________________________________________________________________ Dated the ___ day of _____, 20__. Petitioner: _________________________ ___________________ State's Attorney ______________ County, South Dakota (OR) Petitioner: __________ State of South Dakota SS. County of __________

_____, being first duly sworn on oath, deposes and states that (s)he is the Petitioner in the foregoing PETITION and that its contents are true according to the best information and belief of the Petitioner. _________________________________
Subscribed and sworn before me on this the ___ day of _____, 20__. (SEAL) _________________________________ (Signature of Officer) _________________________________ (Title of Officer)
Source: SL 1991, ch 217, § 177.

FORM 5 SUMMONS AND NOTICE OF HEARING

(SDCL 26-7A-44)

THE STATE OF SOUTH DAKOTA SENDS GREETINGS TO THE ABOVE-NAMED CHILD(REN), PARENTS, GUARDIANS, CUSTODIAN OR OTHER RESPONDENTS, AND ALL WHOM IT MAY CONCERN.
You are hereby notified that a Petition has been filed in the above-named Court alleging the above-named child(ren) to be abused or neglected according to provisions of SDCL 26-7A and SDCL 26-8A for the reasons stated in the Petition.
You are hereby summoned to appear, either in person or by attorney, before this Court at _____ o'clock __.m., on _____, the ____ day of _____, 20__, at the Courtroom in the Courthouse in _____, _____ County, South Dakota, to answer to the Petition. Failure to appear shall be deemed an admission to the allegations contained in the Petition. The above-named child(ren) shall not appear before the Court unless otherwise required by the Court. If you [and the child(ren) if required by the Court] fail to appear, a warrant may be issued by the Court requiring that you [and the child(ren) if required by the Court] be brought before the Court.
You are hereby notified that termination of your parental rights is a possible remedy under the proceedings. You and the child(ren) have the right to an attorney at all stages of the proceedings. According to the Petition filed in the Court, the Indian Child Welfare Act (is not) (is) applicable.
The Court (does not) (does) require the child(ren) to appear before the Court.
Dated the _____ day of _____, 20__.
BY THE COURT: (SEAL) ATTEST: _____________________________________ JUDGE ____________ JUDICIAL CIRCUIT COURT CLERK OF COURTS STATE OF SOUTH DAKOTA __________ COUNTY, SOUTH DAKOTA
Source: SL 1991, ch 217, § 178.

FORM 6 SUMMONS AND NOTICE OF HEARING

(SDCL 26-7A-44)

THE STATE OF SOUTH DAKOTA SENDS GREETINGS TO THE ABOVE-NAMED CHILD(REN), PARENTS, GUARDIANS, CUSTODIAN OR OTHER RESPONDENTS, AND ALL WHOM IT MAY CONCERN.
You are hereby notified that a Petition has been filed in the above-named Court alleging the above-named child(ren) to be [child(ren) in need of supervision] [delinquent child(ren)], as defined by SDCL 26-7A and (SDCL 26-8B) (SDCL 26-8C).
You are hereby summoned to appear, either in person or by attorney, with the child(ren) before this Court at _____ o'clock __.m., _____, the _____ day of _____, 20__, at the Courtroom in the Courthouse in _____, _____ County, South Dakota, to answer to the Petition. Failure to appear shall be deemed an admission to the allegations contained in the Petition. If you and the child(ren) fail to appear, a warrant may be issued by the Court requiring that you and the child(ren) be brought before the Court. You and the child(ren) have the right to an attorney at all stages of the proceedings. According to the Petition filed in this Court, the Indian Child Welfare Act (is not) (is) applicable.
Dated the _____ day of _____, 20__.
BY THE COURT: (SEAL) ATTEST: __________________________________ JUDGE ___________________________________ _________ JUDICIAL CIRCUIT COURT CLERK OF COURTS STATE OF SOUTH DAKOTA __________ COUNTY, SOUTH DAKOTA
Source: SL 1991, ch 217, § 178.

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