Form 253 (Rev 5/16) The Family Court of the State of Delaware In and For Name Street Address (including Apt) P.O. Box Number City/State/Zip Code Phone Number Attorney Name D.O.B. New Castle Name Kent Sussex County File Number MOTION TO CONTEST ADMINISTRATIVE ADJUSTMENT . Street Address (including Apt) Petition Number P.O. Box Number City/State/Zip Code Phone Number Attorney Name D.O.B. DCSS Number (the "Movant") has received a Notice of Administrative Adjustment filed with the Family Court by the Division of Child Support Services (DCSS). The Movant DISAGREES with the: Date of Termination of Current Support. Balance (amount) of past due child support (back support / arrears). Monthly amount ordered to repay past due child support (back support / arrears). Change of Payee (The person alleged does not have placement of the child(ren)). Date of Change of Payee (Movant disagrees with the date alleged for the change in placement). Because: MOVANT AFFIRMS that the above information is true and correct and that a copy of this motion was deposited in the U.S. Mail on with sufficient postage and addressed to: the Division of Child Support Services (appropriate county address on reverse of form) and the opposing party at Movant/Attorney Sworn to subscribed before me: Clerk of Court/ Notary Public Date Date NOTICE: RESPONDENT HAS THE RIGHT TO FILE A RESPONSE WITHIN TEN (10) DAYS OF THE SERVICE OF THIS MOTION. IF NO RESPONSE IS TIMELY FILED, THE MOTION MAY BE DECIDED WITHOUT OTHER OPPORTUNITY TO BE HEARD. Upon consideration of the Motion, the Notice of Administrative Adjustment and the response (or) no response, the Court ORDERS the following: The motion is DENIED. The Administrative Adjustment was correct and authorized by Family Court Civil Rule 302. The motion is GRANTED and: Current Support terminated (or shall presumptively terminate) on The correct arrears balance is $ as of Arrears shall be repaid at the rate of $ per month The correct payee is effective A hearing will occur on at AM PM to consider this motion ( date/time TBD). Other: So Ordered this Date: Judge/Commissioner 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Form 253 (Rev 5/16) CC: FILE PARTIES DCSS Counsel DCSS Accounting DCSS Operations Reciprocal Agency 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Form 253 (Rev. 4/07) Page 2 FOR ALL CHILD SUPPORT CASES HANDLED THROUGH THE DIVISION OF CHILD SUPPPORT SERVICES (DCSS), A COPY OF THIS NOTICE AND MOTION TO CONTEST AN ADMINISTRATIVE ADJUSTMENT MUST BE SENT TO THE DCSS OFFICE IN THE COUNTY WHERE YOUR CASE IS LOCATED. IF YOUR CASE IS LOCATED IN NEW CASTLE COUNTY, SEND COPY TO: DIVISION OF CHILD SUPPORT SERVICES P.O. BOX 15012 WILMINGTON, DE 19850 IF YOUR CASE IS LOCATED IN KENT COUNTY, SEND COPY TO: DIVISION OF CHILD SUPPORT SERVICES 1114 SOUTH DUPONT HIGHWAY SUITE 101 DOVER, DE 19901 IF YOUR CASE IS LOCATED IN SUSSEX COUNTY, SEND COPY TO: DIVISION OF CHILD SUPPORT SERVICES 9 ACADEMY STREET GEORGETOWN, DE 19947 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com