STATE OF SOUTH DAKOTA )

IN CIRCUIT COURT

) ss

COUNTY OF ______________)

_____ JUDICIAL CIRCUIT

THE PEOPLE OF THE STATE OF )

Juv. No.__________

SOUTH DAKOTA IN THE INTEREST)

OF ____________________________, )

NOTICE TO PARENT, CUSTODIAN,

MINOR CHILD(REN), AND )

OR INDIAN TRIBE OF CHILD CUSTODY

CONCERNING __________________, )

PROCEEDINGS (ICWA)

_______________________________, )

RESPONDENTS. )