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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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