Appearance by a Self-Represented Litigant in a Civil Case

STATE OF INDIANA

DELAWARE COUNTY

SS:

IN THE DELAWARE CIRCUIT

COURT NO.

Petitioner

Respondent

CAUSE NO. 18C0

1. My Name:

2. My Address:

3. My telephone number:

4. My fax number:

5. My e-mail address:

6. I will accept service from other parties by:

FAX at the above noted number: Yes No

Email at the above noted address: Yes No

7. This case involves child support issues: Yes No

(If yes, supply Social Security Numbers for all family members on a separately
Attached document filed as confidential information on light green paper. Use
Form TCM-TR3.1-5.)