Form 198LTR Rev 6/18 *** ATTENTION *** This is to inform you that, because of your history of non-payment of child support, any further finding of contempt in this case may result in your incarceration. You now have the right to be represented by an attorney for any further child support contempt/arrears proceedings in this case. If you apply to the Court and are determined to be unable to afford an attorney, one may be appointed to represent you. In order for the Court to determine whether you are indigent and entitled to a court-appointed attorney, you must complete the attached: APPLICATION TO BE FOUND INDIGENT AND REQUEST FOR APPOINTMENT OF AN ATTORNEY IN CHILD SUPPORT ARREARS PROCEEDINGS The original form must be filed as soon as possible after the summons issues advising you that a child support arrears petition has been filed. The form must be filed at the following address: THIS WILL BE THE ONLY FORM YOU RECEIVE TO REQUEST APPOINTMENT OF COUNSEL IN A PROCEEDING INVOLVING NON-PAYMENT OF CHILD SUPPORT. IF YOU NEED THIS FORM IN THE FUTURE, CONTACT FAMILY COURT IN PERSON OR YOU CAN OBTAIN THE FORM ON THE COURT222S WEBSITE http://courts.delaware.gov/family/ Family Court New Castle County 500 N. King Street Wilmington, DE 19801 302 - 255 - 0300 Family Co urt Kent County 400 Court Street Dover, DE 19901 302 - 672 - 1000 Family Court Sussex County 22 The Circle Georgetown, DE 19947 302 - 855 - 7400 American LegalNet, Inc. www.FormsWorkFlow.com Form 198A Rev 6/18 The Family Court of the State of Delaware In and For New Castle County Kent County Sussex County APPLICATION TO BE FOUND INDIGENT AND REQUEST FOR APPOINTMENT OF AN ATTORNEY IN CHILD SUPPORT ARREARS PROCEEDINGS Petitioner v. Respondent I declare that I am the respondent in the above-captioned case(s), that I have been advised incarceration is a possible outcome and that I am unable to afford counsel. I respectfully request the Court to appoint counsel. I am am not presently employed Current monthly salary $ If not employed, monthly salary from previous job $ Date last employed Reason for unem ployment If self - employed, average monthly income $ $ TOTAL income from employment (a) I receive monthly payments from the following: TANF/General Assistance/Food stamps $ $ Pension $ Unemployment Compensation $ Workers222 Compensation or Disability Payments $ Social Security Disability $ Supp lemental Security Income $ Other $ TOTAL income from monthly payments (b) TOTAL from income and payments (a+b) $ I make monthly payments on the following debt s Child Support $ Rent/Mortgage $ Automobile Loan $ Personal or other loans $ Other $ TOTAL monthly payment on debts (c) Available income (a+b - c) $ $ I have $ in cash and $ In checking and/or savings Name Name File Number Street Address (Including Apt) . Street Address (Including Apt) P.O. Box Number P.O. Box Number Petition Number City/State/Zip Code City/State/Zip Code Phone Number D.O.B. Phone Number D.O.B. A ttorney Name Attorney Name Interpreter needed? Yes No Interpreter needed? Yes No Language Language American LegalNet, Inc. www.FormsWorkFlow.com Form 198A Rev 6/18 OTHER INCOME AND ASSETS THAT MAY BE CONSIDERED: I have received money from the following in t he last 12 months Life Insurance $ Gifts or inheritance $ Other Sources $ I own the following, including estimated value: Real Estate $ Stocks and Bonds $ Cars or other vehicles $ Other Property $ Affiant Sworn to subscribed before me this day of , Clerk of Court/ Notary P ublic Date ORDER Upon review of the foregoing, IT IS SO ORDERED: The Application is DENIED. The Application is GRANTED and is appointed to represent the resp ondent on this petition. The hearing is scheduled for: Other: Date Judge/Commissioner CC: Petitio ner Respondent DAG Appointed Counsel FC.Appointed.Attorneys@state.de.us Attachment: Packet for Respondent222s Counsel American LegalNet, Inc. www.FormsWorkFlow.com