Fill and Sign the Motion to Be Found Indigent and Request for Appointment of an Attorney in Child Support Proceedings Delaware Form

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 Petitioner Respondent File Number Address V S Address Petition Number(s) City State Zip City State Zip Attorney Attorney 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: I have received money from the following sources in the last 12 months: FILM Form 198 (Rev. 3/07) 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, , affi that a tfue and coffect copy of Motion was placed in the U.S. Mail on the day of , , and sent to the last known addfess of the othef pafty of attofney, being , ffst class postage pfepaid. Movant/Attofney/Couft Staf SWORN TO AND SUBSCRIBED befofe ie this date, . Notafy Public