Form 127A Rev 08/13 The Family Court of the State of Delaware In and For New Castle Kent Sussex County AFFIDAVIT AND REQUEST TO REGISTER A FOREIGN SUPPORT ORDER Petitioner Name Street Address (including Apt) P.O. Box Number City/State/Zip Code Date of Birth Attorney Name v. Respondent Name Street Address (including Apt) P.O. Box Number City/State/Zip Code Date of Birth Attorney Name Petition Number File Number Interpreter needed? Language: Yes No Interpreter needed? Language: Yes No , ("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 support 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 arrearages owed are: $ _____________. 4. I have provided below the name, address and social security number of the obligor, listed as Respondent, above. 5. The name and address of the obligor's employer is: Name Street Address (including Apt) P.O. Box Number City/State/Zip Code BE IT REMEMBERED, that on this date, 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Form 127A Rev 08/13 6. If the obligor owns property in Delaware that is not exempt from execution, that property is located at the following address: Street Address (including Apt) P.O. Box Number City/ State/ Zip Code 7. I have simultaneously filed a petition or comparable pleading seeking enforcement of this Order. Affiant SWORN TO AND SUBSCRIBED before me this date Clerk of Court/Notary Public 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com