Non-Paternity Affidavit Page 2

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Petitioner’s Current Assistance (Government Program or Private Assistance)
From
Amt.
Frequency
Purpose
Defendant’s Current Assistance (Government Program or Private Assistance)
From
Amt.
Frequency
Purpose
PETITIONER SIGNATURE
Subscribed and sworn to before me this
day of
20
(Notary Public),
County.
My commission expires
20

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