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PATERNITY NOTIFICATION AFFIDAVIT

 

Putative Father's Name: __________________Biological Mother's Name:_____________________

PATERNITY NOTIFICATION AFFIDAVIT, completed by ( )Biological Mother ( ) Legal Guardian

This form is REQUIRED to establish paternity for the child listed based on DNA genetic testing with a minimum Paternity Index of 2,000 to 1. Take this information to the Attorney of your choice to create an enforceable document based on your state laws with emphasis on statutes for perjury, fraud and misrepresentation.

Child's Name on Birth Certificate:_______________________________ Date of Birth:___/____/____

Child was conceived in: City, State:_____________________________

Hospital where child was born:__________________________ City, State:__________________
 Date of Conception: ___/___/___ , Original Est. Delivery Date: __/__/__ Length of pregnancy at birth (gestational age in weeks)____________

Marital Status at child's birth: Mother: _________________________ Putative Father:  ________________________

If biological mother was married at birth, to whom?: _______________________________________

POSSIBLE FATHER(s):

Is the putative father "the only possible biological father of the child?"__________________ Fill in YES or NO  

Did the biological Mother have sexual intercourse with anyone other than the putative father within 60 days of becoming pregnant? _____________ Fill in YES or NO

If so, name:_________________________ Address:__________________________

If so, name:_________________________ Address:___________________________

Did the biological mother inform the listed possible fathers in writing, of this child? ( ) Yes ( ) No
If so, when and attach proof? ________________ If not, why not? _________________________ 
___________________________________________________

Has the Biological Mother ever named anyone else as the father of this child? ( ) Yes ( ) No 

If yes, name: ____________________ Address: ________________________

If yes, name: ____________________ Address: ________________________

Has DNA paternity testing ever been done on this putative father for this child? ( ) Yes ( ) No
What were the results?_______________________Paternity Index is_____________%_ (Attach copy of results)

Has DNA paternity testing ever been done on any other male for this child ? ( ) Yes ( ) No, 
What were the results?_______________________Paternity Index is_____________%_ (Attach copy of results)

Personally appeared before the undersigned officer, duly authorized to administer oaths, the undersigned who states under oath that the foregoing statements are true and correct. I understand that medical tests will be required to confirm actual paternity for the above child. I will cooperate with genetic testing and all legal actions to establish paternity for the child.

So sworn and affirmed,

Mother / Guardian's Signature:_______________________________ SSN _____-____-_____ Date:____/____/____

Notary Public Signature: __________________________ Commission Expiration Date:____/____/_____

NOTARY SEAL:

 

PATERNITY NOTIFICATION AFFIDAVIT form created by Carnell Smith

Copyright © 2001-2011, Carnell Smith, PaternityFraud.com, all rights reserved.

Maybe freely copied or used provided the attribution line is kept intact.

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