Fill and Sign the Full Text of Ampquotarkansas District Court Clerks Manual 062010ampquot Form

IN THE CHANCERY COURT OF COUNTY, MISSISSIPPI DISTRICT PLAINTIFF VS. NO. DEFENDANT SSN: AFFIDAVIT AND AFFIRMATION OF PATERNITY THIS DAY PERSONALLY CAME AND APPEARED BEFORE ME, the undersigned authority in and for the aforesaid jurisdiction, the within named , who first havi ng been by me duly sworn, states on oath the following: 1. That this Affidavit is made upon information that is within my personal knowledge and my belief thereof; 2. That I am competent to swear to the matters stated herein; 3. That I do execute this Affidavit and Affirmation of Paternity for the specific purpose of complying with Section 43-19-33 et. seq. of the Mississippi Code (1972), as amended; and other applicable Statutes and Regulations; 4. That I have read and do understand the statements made herein and further state that I do freely and voluntarily make and execute this Affidavit under penalty of perjury; 5. That is the natural father of my child(ren), whose full name(s) and date(s) of birth are listed below, and that as a result of our relationship he/she/they were born out of wedlock: NAME BIRTH DATE 6. That I am not aware of any previous paternity action in which was rendered a judgment of paternity involving myself and our child listed above. __________________________________________ AFFIANT SWORN TO AND SUBSCRIBED before me on this the day of , A. D., 20 . __________________________________________ NOTARY MY COMMISSION EXPIRES: