Fill and Sign the Information About Child Support Services and Applicationrefer R Al for

Agreement By Natural Father to Support Child Born out of Lawful WedlockChild support agreement made on the ___________________________________ (date) , between _____________________________________ (Name of Natural Father) of _____________________________________________________________________ ___________________________________ (street address, city, county, state, zip code), referred to herein as Father, and __________________________________________ (Name of Natural Mother) of _______________________________________________ ___________________________________________________________________________________ (street address, city, county, state, zip code) , referred to herein as Mother; Whereas, Mother gave birth to a ___________________ (male or female) child, named __________________________________ (Name of Child), referred to herein as Child , on ______________________________________ (date), at _________________ _________________________________________________ (name of hospital), located at ______________________________________________________________________ ____________________________________________________________________________________ (street address, city, county, state, zip code) ; and Whereas, Mother has, and shall continue to have, exclusive custody of Child; and Whereas, Father admits that he is the father of Child, and agrees to assume liability for the support of Child; and Whereas, the parties to this agreement are not now, and have never been, married to each other; Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Payments for Support Father agrees to pay, or cause to be paid, to Mother $______________ per (week or month) for the care and support of Child. The first payment of $______________ shall be due and payable on ________________________________________ (date), and subsequently on ___________________________ (day of week or month) until Child reaches school age. Father then agrees to pay Mother $_______________ per ______________________ (week or month) for the care, support, and education of Child until Child reaches the age of _________years or until the death of Child, the marriage of Child, or (set forth any additional contingency) ________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________, whichever event occurs first. 2. Payment of Medical Expenses Father shall also pay or cause to be paid to Mother $_______________ to compensate her for medical expenses incurred by her in connection with her pregnancy, confinement, and recovery, as follows: (itemize each expense and set forth amount allocated to each) ________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________. 3. No Paternity Proceedings In consideration for the payments to be made by Father, Mother agrees not to institute any action or proceedings in any court to establish judicially the paternity of Child, or to obtain an order for payments from Father for the care, support, or education of Child . 4. Visitation Rights As further consideration for the agreement of Father to make the payments, Mother agrees that Father shall have the right to visit Child at Mother's place of residence at reasonable times and at reasonable intervals, and to have Child accompany him from Mother's place of residence at reasonable times and for reasonable periods, provided that Mother's prior approval and consent have been obtained whenever such rights are exercised by Father. Mother agrees not to withhold her approval and consent without good cause. 5. Death of Father A.In the event of Father's death during the period in which support payments are due and payable under this agreement, the continuation of such support payments shall constitute an obligation of, and charge against, Father's estate until the obligation is terminated as provided. Mother, at her option, may accept a lump-sum payment in full settlement of such obligation. B.To satisfy the obligation set forth in the Paragraph A of this Section, Father agrees, for as long as such obligation remains, that he shall obtain and maintain in force suitable and sufficient insurance on his life, with the proceeds payable (state to whom proceeds are payable, such as Mother or a trustee of a trust, and the amounts and the dates payments will be made and for what purposes) _____________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. 6. Default If Father fails to make any payment due under this agreement within __________ (number) days after such payment is due, Mother, at her option, may rescind this agreement and take any action and institute any proceeding available to her under the laws of ____________________________________ (name of state). 7. No WaiverThe failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. 8. Governing Law This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of _______________________________. 9. Notices Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 10. Attorney’s Fees In the event that any lawsuit is filed in relation to this Agreement, the unsuccessful party in the action shall pay to the successful party, in addition to all the sums that either party may be called on to pay, a reasonable sum for the successful party's attorney fees. 11. Entire Agreement This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. 12. Modification of Agreement Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party. 13. Assignment of Rights The rights of each party under this Agreement are personal to that party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other party. 14. Counterparts This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute but one and the same instrument. WITNESS our signatures as of the day and date first above stated. ___________________________________ ______________________________ (Printed name) (Printed Name) ____________________________________ ______________________________ (Signature of Mother) (Signature of Father)