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CONFIDENTIAL INFORMATION FORM (Required by SDCL 15-15A-9) Plaintiff/Petitioner Defendant/Respondent The information on this form is protected and shall not be placed in a publicly accessible portion of the court record. The filing documents will be placed in the public part of the court record devoid of this information. SOCIAL SECURITY NUMBER, EMPLOYER IDENTIFICATION NUMBER, TAXPAYER IDENTIFICATION NUMBER, AND FINANCIAL ACCOUNT NUMBERS Case No.

NAME Plaintiff/Petitioner 1. Defendant/Respondent 1. Others Parties (including minor children) 1. 2. 3. 4. 5. 6. 7. 8. Information supplied by: Signed: Firm: Address: Date:

Documents to be recorded in the Register of Actions by caption as confidential.

Rev. July 1, 2006