APPEARANCE BY A SELF-REPRESENTED LITIGANT IN A CIVIL CASE

STATE OF INDIANA

DELAWARE COUNTY

SS:

IN THE DELAWARE CIRCUIT

COURT NO.

Petitioner/Plaintiff

Respondent/Defendant

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.)