Affidavit In Support Of Establishing Paternity (Page 5 of 7) in pdf

Item 2: Enter the name of the child's other parent in the blank. This is the person with whom you

(the parent completing the affidavit) had sexual intercourse which resulted in the child's conception.

Item 3a: Check "Yes" or "No" to indicate whether or not a man is named as the child's father on the

child's birth certificate. If "Yes", attach a copy of the birth certificate and provide the man's name and

address. The man may be the same man who is named as the father of the child in this affidavit, or he

may be a different man.

Item 3b: Check "Yes" or "No" to indicate whether or not a man was married to the child's natural

mother and the child's birth occurred within a year of the end of the marriage. If "Yes", provide the

man's name and address. The man may be the same man who is named as the father of the child in

this affidavit, or he may be a different man.

Item 3c: Check "Yes" or "No" to indicate whether or not a man signed an acknowledgment of

paternity. If "Yes", attach a copy of the acknowledgment and provide the man's name and address.

The man may be the same man who is named as the father of the child in this affidavit, or he may be a

different man.

Item 3d: Check "Yes" or "No" to indicate whether or not a man acted as and presented himself to be

the child's father. If "Yes", provide the man's name and address. The man may be the same man

who is named as the father of the child in this affidavit, or he may be a different man.

Item 3e: Check "Yes" or "No" to indicate whether or not genetic tests (e.g., blood tests) were

completed to determine the father of the child. If "Yes", attach the test results.

SECTION II: (To be completed by Mother Only)

Item 1: Check "Yes" or "No" to indicate whether you (the mother) did or did not have sexual

intercourse (sex) with another man or other men during the 30 days before or the 30 days after the

child was conceived ("Date Mother Got Pregnant").

If you had sexual intercourse with another man or other men during this period (30 days before or 30

days after), complete items 1a through 1c.

Item 1a: Provide the name(s) and address(es) of the other man/men.

Item 1b: Check "Yes" or "No" to indicate whether the other man/men are biologically related

to the alleged father. If "Yes", state the relationship (e.g., brother, cousin, etc). This may be

relevant to genetic testing.

Item 1c: Explain why you do not believe the other man/men is/are the father of this child (e.g.,

prior exclusion by genetic testing).

Item 2: Check "Yes" or "No" to indicate whether or not you were married at the time of the child's

birth. If "Yes", complete items 2a and 2b.

Item 2a: Provide the name and address of your husband (at the time of the child's birth).

Item 2b: Explain why the husband is not the father. Attach appropriate documents.

Item 3: Be sure to enter the name of the father of this child. Check the appropriate answer for each

statement (a - q) to support the allegations of paternity against the alleged father. Remember to attach

any necessary, relevant documentation. This includes a certified copy of the birth certificate with the

Instructions for Affidavit in Support of Establishing Paternity--Page 2

Affidavit In Support Of Establishing Paternity Page 5