IN THE SUPREME COURT OF THE STATE OF DELAWARE (1) , ) (2) Below, ) Appellant, ) (5) No. ) v. ) ) (3) , ) (4) Below, ) Appellee. ) AFFIDAVIT REQUESTING TO PROCEED PRO SE PURSUANT TO RULE 26(d)(iii) STATE OF DELAWARE ) ) SS. COUNTY O F ( 6) ) I (7) , being first duly sworn upon oath deposes and says: I am the appellant in the above captioned direct appeal, and I wish to discharge my attorney and represent myself in this appeal. I request the Supreme Court to remand my cas e to the Superior Court for an evidentiary hearing pursuant to Supreme Court Rule 26(d)(iii) to determine whether my request to proceed pro se on appeal is intelligently and voluntarily based. I acknowledge that the Supreme Court will take no further acti on on my appeal pending a ruling by the Superior Court. DATE NAME ADDRESS SUBSCRIBED AND SWORN to me before this day of , 20 . NOTARY PUBLIC My commission expires . American LegalNet, Inc. www.FormsWorkFlow.com Insert: [1] Appellant's name. [2] Appellant's lower court status. [3] Appellee's name. [4] Appellee's lower court status. [5] Supreme Court appeal number. [6] County. [7] Appellant' s name. American LegalNet, Inc. www.FormsWorkFlow.com