Form 650 (Rev. 1/10) The Family Court of the State of Delaware In and For New Castle Kent Sussex County MOTION AND AFFIDAVIT FOR EMERGENCY EX PARTE ORDER Petition for (This form is not to be used in Protection from Abuse matters. To request a PFA ex parte order, please use Form 654) Movant Name: Respondent Name: File Number Petition Number I, the undersigned movant, being duly sworn according to law, do hereby attest to the truth of the allegations made in the underlying petition. I request that an Emergency Ex Parte Order be issued without notice to the Respondent. 1. Notice to the Respondent should not be given for the following reason(s): 2. I request the following specific relief: 3. I further attest that unless relief is granted on an ex parte basis, the following immediate and irreparable harm will result: Movant Sworn to subscribed before me this day of , Clerk of Court/ Notary Public Date American LegalNet, Inc. www.FormsWorkFlow.com