Form 198 (Rev. 03/12) The Family Court of the State of Delaware In and For New Castle Kent Sussex County MOTION TO BE FOUND INDIGENT AND REQUEST FOR APPOINTMENT OF AN ATTORNEY IN CHILD SUPPORT PROCEEDINGS Petitioner Name Street Address P.O. Box Number City/State/Zip Code Phone Number Attorney Name Interpreter needed? Language Yes No D.O.B. v. Respondent Name . Street Address P.O. Box Number City/State/Zip Code Phone Number Attorney Name Interpreter needed? Language Yes No D.O.B. File Number Petition Number I declare that I am the respondent in the above-captioned case; that I believe incarceration is a possible outcome; and that because of my poverty I am unable to retain 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 unemployment If self employed, average monthly income TOTAL income from employment (a) I receive monthly payments from the following: Pension Unemployment Compensation Workers' Compensation or Disability Payments Interest or Dividends Other TOTAL income from monthly payments (b) TOTAL from income and payments (a+b) I make monthly payments on the following debts Child Support Mortgage Automobile Loan Personal or other loans Other TOTAL monthly payment on debts (c) Available income (a+b-c) I have $ in cash and $ 1 of 4 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ In checking and/or savings American LegalNet, Inc. www.FormsWorkFlow.com Form 198 (Rev. 03/12) OTHER INCOME AND ASSETS THAT MAY BE CONSIDERED: I have received money from the following in the last 12 months Life Insurance Other Sources $ $ Gifts or inheritance $ I own the following, including estimated value: Real Estate Cars or other vehicles $ $ Stocks and Bonds Other Property $ $ Movant Sworn to subscribed before me this day of , Clerk of Court/ Notary Public Date AFFIDAVIT OF MAILING I, the Movant, affirm that a true and correct copy of this Motion was placed in the U.S. Mail on the day of and sent to the other party or attorney at the address listed on the petition, first class postage pre-paid. Movant Sworn to subscribed before me this ______ day of ______________________, _________ Clerk of Court/ Notary Public 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Form 192 (Rev. 10/10) The Family Court of the State of Delaware In and For New Castle , Petitioner Kent Sussex County v. , Respondent ) ) ) ) ) ) ) ) ) File No.: Petition No.: NOTICE OF MOTION TO: PLEASE TAKE NOTICE that the attached Motion is herewith presented to the Court for consideration. If you are opposed to this motion, you must file a written response with the Court within ten (10) days of the service of this motion. If no response is timely filed, the motion may be decided without further opportunity for you to be heard on the matter. Family Court Rules, Rule 7(b)(2). Date Movant/Attorney Name and address of Movant/Attorney Street Address P.O. Box Number City/State/Zip Code 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Form 193 (Rev. 03/12) The Family Court of the State of Delaware In and For New Castle Kent Sussex County ) ) ) ) ) ) ) ) ) , Petitioner File No.: Petition No.: In Re: v. , Respondent ORDER Having considered the request of the movant, IT IS SO ORDERED, this date: , That Judge/Commissioner cc: 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com