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STATE OF SOUTH DAKOTA ) :SS COUNTY OF _______________) _________________________, Plaintiff, vs. _________________________, Defendant

IN CIRCUIT COURT ________ JUDICIAL CIRCUIT DIV _______ AFFIDAVIT OF PLAINTIFF AND DEFENDANT AS TO JURISDICTION AND GROUNDS FOR DIVORCE

____________________________________, Plaintiff and ___________________________, Defendant, being first duly sworn upon their oath, depose and state as follows: 1. That they are the Plaintiff and the Defendant in the above-entitled divorce action. 2. This Affidavit is made pursuant to SDCL 25-4-17.3 so that the divorce action may be submitted to the Court without the personal appearance of either party. 3. That the Plaintiff, at the time of the commencement of this divorce action was, and at all times material herein is, a bona fide resident of _______________________________ of the State of South Dakota (or stationed in the State of South Dakota while a member of the armed forces) and has continued to reside in said state from the commencement of this divorce action to the present time. 4. Plaintiff and Defendant agree by execution of this Affidavit that there are irreconcilable differences between the parties which have caused the irremediable breakdown of their marriage and consent to the Court's entry of a Decree of Divorce to both parties on the grounds of irreconcilable differences. Dated this ________________day of _________________________, 2_____.

Form UJS-319 Rev. 11/08

_________________________________________ (Signature of Plaintiff SUBSCRIBED AND SWORN to before me this ______ day of _______________, 2_______.

_________________________________________ Notary Public/Clerk of Court If notary, my commission expires:

Dated this _________________day of ___________________________, 2_______.

__________________________________________ (Signature of Defendant) SUBSCRIBED AND SWORN to before me this ______ day of ________________, 2_______.

__________________________________________ Notary Public/Clerk of Court If notary, my commission expires:

(SEAL)

Form UJS-319 Rev. 11/08