Form 475 (Rev. 5/08) The Family Court of the State of Delaware In and For New Castle Kent Sussex County AFFIDAVIT AND REQUEST TO REGISTER A FOREIGN PROTECTION ORDER Petitioner Name Street Address Apt. or P.O. Box Number City State Zip Code v. Respondent Name Street Address Apt. or P.O. Box Number City State Zip Code File Number Petition Number Attorney Name and Phone Number Attorney Name and Phone Number 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 protection order issued by a Court of 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 is currently in effect and has not been replaced, modified, or vacated by a more recent order. 4. I further understand that a registered foreign protection order that is inaccurate or that is not currently in effect must be corrected or removed from the registry in accordance with the law of this State. 10 Del. C. §1049D(c) Affiant Sworn to subscribed before me this ______ day of ______________________, _________ Clerk of Court/Notary Public Date Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com