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(PATERNITY NOTIFICATION AFFIDAVIT )
AGREEMENT & AFFIDAVIT
I understand the criminal penalties for making false statements and false swearing and do hereby
attest to the truthfulness of the information provided. [False swearing is punishable by a fine, by imprisonment or
both.] Insert your states statutes for perjury, false swearing, misrepresentation and fraud.
I understand that copies of this notarized Paternity Notification Affidavit must be sent to the
putative father and all possible fathers listed on this affidavit via certified mail + restricted delivery + return
receipt or similar service that requires Identification and signature on delivery.
ESTABLISHING PATERNITY FOR THE CHILD LISTED
I acknowledge that I am the biological mother or legal guardian of the child listed in this
Affidavit. This Paternity Acknowledgment Affidavit has been given of my own free will and volition, and I
understand that under the Laws of the State of __________, and at some time in the future, I may be liable to
furnish support for the child named herein, until said child has emancipated.
I understand that the child(ren) and I will be required to submit to genetic testing for
paternity determination, and am so willing to cooperate, to establish paternity for the child. Except for legally
adopted children and certain cases of births resulting from artificial insemination. See Paternity Testing section
for more information.
PATERNITY TESTING: If paternity has not been determined by genetic testing, testing will be
required to determine paternity. If the putative father is the biological father, the biological mother or legal
guardian will have right of action for child support except for non-adopted children and certain pregnancies
resulting from unauthorized artificial insemination. In all cases of artificial insemination, the mother or legal
guardian must provide copy of notarized written consent to the procedure, signed by the biological mother, the
putative father and the treating physician to have right of action for child support.
COST OF TESTING: Initial fees for genetic testing will be split on a 50 percent basis by
the biological mother or legal guardian and the putative father. If the putative father is not the biological
father, he shall be reimbursed in full by the initiating party for all costs associated with defending the false
allegation of paternity.
RELEASE OF SUPPORT:
If any of the following conditions apply to the putative father, he shall be released from all
responsibility for the child, including child support, arrears and other expenses:
The putative father is not the biological father based on paternity index below a ratio of 1,000
The putative father is not the legally adopted father.
The putative father did not consent (written and notarized) to the artificial insemination,
signed by his Wife, the biological mother and the treating physician. If this child is born by a surrogate mother
using the putative father's sperm then his wife shall have cause of action for child support purposes.
PROOF OF NON-PATERNITY: If the putative father meets any of the criteria above for release of
support, he will receive an official order of non-paternity and full release of all obligations for the child
listed on this form.
PATERNITY NOTIFICATION AFFIDAVIT form created by Carnell Smith
Copyright © 2001-2011, Carnell Smith, PaternityFraud.com , all rights
Maybe freely copied or used provided the attribution line is kept
Paternity Fraud is a crime, crime does NOT PAY and neither should the