Form 182 (Rev. 6/10) The Family Court of the State of Delaware In and For Petitioner Name New Castle Respondent Name Kent Sussex County AFFIDAVIT AND REQUEST TO REGISTER A FOREIGN CUSTODY ORDER File Number Street Address Street Address P.O. Box Number P.O. Box Number Petition Number City/State/Zip Code City/State/Zip Code Attorney Name Attorney Name BE IT REMEMBERED, that on this date, , ("Petitioner"), who, being duly sworn by me according to the law personally appeared before me, a Notary Public for the State and County declared above, did depose and say: 1. I hereby request that the Family Court of the State of Delaware register the attached child custody order issued by a court of another state. 2. I have attached two (2) copies of said Order, at least one (1) of which is a certified copy. 3. To the best of my knowledge and belief, the attached Order has not been modified. 4. Below are the names and addresses of any parent or person acting as parent who has been awarded custody or visitation in the child custody determination sought to be registered. Name Name Street Address Street Address P.O. Box Number P.O. Box Number City/State/Zip Code City/State/Zip Code Affiant SWORN TO AND SUBSCRIBED before me this date Clerk of Court/Notary Public Date: cc: Petitioner Other: Respondent American LegalNet, Inc. www.FormsWorkFlow.com