Fill and Sign the Florida Affidavit Form

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(a)(3), AFFIDAVIT OF NONPATERNITY (03/15) When should this form be used? This form should be used when a stepfather is adopting his wife’s minor child and the mother and father of the minor child(ren) were never married and paternity has not been established by a valid acknowledgment or court order. This Afdavit of Nonpaternity may be used instead of a consent form. This Afdavit may be executed before the birth of the minor child. The person signing the afdavit waives notice to all court proceedings after the date it is signed. After signing this afdaviti it may only be withdrawn if the court fnds the afdavit was obtained by fraud or duress. This form should be typed or printed in black ink. This form must be signed before a notary public or deputy clerk and two witnesses other than the notary or clerk. You should then file the original of this form with the Joint Petition for Stepparent Adoption, Florida Supreme Court Approved Family Law Form 12.981(b)(1). IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that petitionsi pleadingsi and documents be fled electronically except in certain circumstances. Self- represented litigants may file petitions or other pleadings electronically; however, they are not required to do so. If you choose to fle your pleadings or other documents electronicallyi you must do so in accordance with Florida Rule of Judicial Administration 2.525i and you must follow the procedures of the judicial circuit in which you fle. The rules and procedures should be carefully read and followed. Special Notes Remember--a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fll out these formsi that person must give you a copy of a Disclosure from Nonlawyer i Florida Family Law Rules of Procedure Form 12.900 (a)i before he or she helps you. A nonlawyer helping you fll out these forms also must put his or her namei addressi and telephone number on the bottom of the last page of every form he or she helps you complete. Instructions for Florida Supreme Court Approved Family Law Form 12.981(a)(3)i Afdavit of Nonpaternity (03/15) IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUITi IN AND FOR __ COUNTYi FLORIDA Case No.: Division: IN THE MATTER OF THE ADOPTION OF ___________________________________________, {use name to of the minor child(ren)} Adoptee(s) AFFIDAVIT OF NONPATERNITY Ii {full legal name} i have personal knowledge of the facts stated in this afdavit and certify that the following statements are true: 1. I have been told that { name } has a child. I do not wish to and shall not establish or claim paternity for this childi whose name is ___________________ and whose date of birth is_____________________________. 2. The child referenced in this afdavit was not conceived or born while the birth mother was married to me. I AM NOT MARRIED TO THE BIRTH MOTHERi nor do I intend to marry the birth mother. 3. The child has not been established to be my child in any court proceeding and I have not adopted this child. 4. I have no interest in assuming the responsibilities of parenthood for this child. I have not acknowledged and will not acknowledge in writing that I am the father of this child or will not institute court proceedings to establish the child as mine. 5. I do not object to any decision or arrangements the birth mother makes regarding this childi including adoption. 6. I understand my right to choose a person who does not have an employmenti professionali or personal relationship with the adoption entity or the prospective adoptive parents to be present when this afdavit is executed and to sign it as a witness. The witness I selected is {full legal name} . 7. I am executing this afdavit freely and voluntarily and I understand that it can only be withdrawn if the court fnds it was executed by fraud or duress. I WAIVE NOTICE OF ANY AND ALL PROCEEDINGS TO TERMINATE PARENTAL RIGHTS OR FINALIZE AN ADOPTION UNDER CHAPTER 63, FLORIDA STATUTES. Florida Supreme Court Approved Family Law Form 12.981(a)(3)i Afdavit of Nonpaternity (03/15) I understand that I am swearing or afrming under oath to the truthfulness of the claims made in this afdavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Signature Printed Name: __________________________________ Address: _______________________________________ Cityi Statei Zip: _________________________________ Designated E-mail Address(es):_____________________ _________________________________________ Signature of Witness Printed Name: Business Address: Home Address: Driver’s License or State ID Card No.: Signature of Witness Printed Name: Business Address: Home Address: Driver’s License or State ID Card No.: STATE OF FLORIDA COUNTY OF Sworn to or afrmed and signed before me on {date } . NOTARY PUBLIC or DEPUTY CLERK [Print, type, or stamp commissioned name of notary or deputy clerk.] _____Personally known _____ Produced identifcation Type of identifcation produced IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fll in all blanks] This form was prepared for the: {choose only one} ( ) parent or ( ) stepparent This form was completed with the assistance of: {name of Florida Supreme Court Approved Family Law Form 12.981(a)(3)i Afdavit of Nonpaternity (03/15) individual} __________________________________ _______________________________i {name of business} ___________________________________________________________________i {address} ___________________________________________________________________________ i {city} ________________i {state} ____i {zip code}_________ {telephone number} ________________. . Florida Supreme Court Approved Family Law Form 12.981(a)(3)i Afdavit of Nonpaternity (03/15)