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Fill and Sign the History Family Court Delaware Courts State of Delaware Form

Fill and Sign the History Family Court Delaware Courts State of Delaware Form

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Form 198(Rev. 3/07) The Family Court of the State of Delaware For  New Castle  Kent  Sussex County MOTION TO BE FOUND INDIGENT AND REQUEST FOR APPOINTMENT OF AN ATTORNEY IN CHILD SUPPORT PROCEEDINGS PetitionerRespondent File Number Address V S Address Petition Number(s) City State Zip City State Zip AttorneyAttorney 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 employment and payments (a+b)$________________ I make monthly payments on the following debts: Child Support $_______________________Mortgage$_______________________Automobile loan$_______________________Personal or other loans $_______________________Other $_______________________ TOTAL monthly payments on debts (c)$_________________Available income (a+b-c)$_________________ I have $_________________________ in cash and $___________________________in checking and/or savings accounts. (OVER) OTHER INCOME AND ASSETS THAT MAY BE CONSIDERED:FILM Form 198(Rev. 3/07)I have received money from the following sources in the last 12 months:Life insurance $_____________________ Gifts or inheritance $_____________________________Other Sources $_____________________I own the following, including estimated value:Real Estate $______________________ Stocks or Bonds $_______________________Cars or other Vehicles $_____________ Other Property $________________________SWORN TO AND SUBSCRIBED before me this date, Notary Public Movant NOTICE: INTENTIIONALLY PROVIDING FALSE, INCOMPLETE OR MISLEADING INFORMATION ON THIS FORM MAY RESULT IN CRIMINAL PROSECUTION ORDER Having considered the request of the movant,________________________________________________________IT IS SO ORDERED, THIS DATE ________________________________________, ________That the movant is determined to be indigent, and the Court shall appoint counsel to represent him/her. ____________________________________________________ Judge/Commissioner AFFIDAVIT OF MAILING STATE OF DELAWARE ) ) ss.: COUNTY OF ) I, , affirm that a true and correct copy of Motion was placed in the U.S. Mail on the day of , , and sent to the last known address of the other party or attorney, being , first class postage prepaid. Movant/Attorney/Court Staff SWORN TO AND SUBSCRIBED before me this date, . Notary Public

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