Form 275 (Rev. 5/16) The Family Court of the State of Delaware In and For New Castle Kent Sussex County STATEMENT OF JURISDICTION OVER A NON-DELAWARE RESIDENT IN A CHILD SUPPORT OR PATERNITY ACTION , Petitioner v. , Respondent ) ) ) ) ) ) ) ) File No.: Petition No.: DCSS No: A petition for new child support or paternity has been filed in this Court in the interest of the child or children named therein. The Petitioner requests the Family Court withhold issuance of summons to the Sheriff or contracted process server and instead issue a summons directly to the Petitioner(s) to attempt service upon the nonresident Respondent pursuant to 10 Del. C. §3104. Petitioner understands that failure to file a return of service within 90 days may cause the petition to be dismissed. Date Petitioner/Attorney The Petitioner alleges upon information and belief that pursuant to 13 Del. C. §6-201 Respondent has sufficient minimum contacts with Delaware, to wit the Respondent: Resided with the child(ren) in Delaware; Resided in Delaware and provided prenatal expenses for the Mother or support for the child(ren); Engaged in sexual intercourse in Delaware and the child may have been conceived by that act; Asserted parentage in the registry of paternity maintained by the Office of Vital Statistics; Agreed in writing to litigate support/paternity in Delaware (copy attached); or Child(ren) reside(s) in Delaware as a result of the acts or directives of the Respondent, specifically Other The Petitioner acknowledges that the filing of this statement/affidavit does not relieve the Petitioner of having to prove at trial the jurisdiction of the Family Court of the State of Delaware over the persons and subject matter of this action. Affiant Date Sworn to subscribed before me this ______ day of ______________________, _________ Clerk of Court/Notary Public American LegalNet, Inc. www.FormsWorkFlow.com