APPENDIX A

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APPENDIX TO CHAPTER 16-21A

DOCUMENT RETURN REQUEST FORM

STATE OF SOUTH DAKOTA, ) In Circuit Court)County of ___________________ ) _______________ Judicial CircuitA. B., ) Plaintiff ) vs. ) DOCUMENT RETURNC. D., ) REQUESTDefendant ) I am requesting that the following document(s) submitted for scanning or as a trial exhibit in the above-named case be returned:List documents to be returned_____ I request that the document(s) be returned by mail and have enclosed a self-addressed stamped envelope._____ I will pick up the document(s) on __________.Dated ____________________Signed: ____________________ Party or Party's Attorney of RecordAddress: ____________________RETURN RECEIPTReceived document(s) this ____ day of __________, __________.Signed: ____________________

Source: SL 2014, ch 254 (Supreme Court Rule 13-12), eff. July 1, 2014.