Legal Paternity Affidavit

LEGAL PATERNITY AFFIDAVIT

Affiant Name:   Affiant Date of Birth:

Mother Name:   Mother Date of Birth:

Child Name:   Child Date of Birth:

RECITALS

WHEREAS, Affiant affirms that Affiant is an adult person of sound mind and is the alleged biological father of the child named above; and

WHEREAS, Affiant seeks to establish and acknowledge legal paternity and to set forth the facts and legal effect of that acknowledgement for the purpose of birth records, government and private benefits, and potential court proceedings; and

WHEREAS, Mother consents to the submission of this affidavit for the establishment of paternity and related administrative or judicial use as necessary to effectuate parental rights and obligations.

NOW, THEREFORE

Affiant hereby declares and avers under penalty of perjury the following statements are true and correct to the best of Affiant's knowledge:

1. Acknowledgment of Paternity. Affiant acknowledges that Affiant is the biological father of the child named above and acknowledges legal paternity for all purposes permitted by law, including but not limited to inclusion on the child's birth certificate, enforcement of support obligations, and exercise of parental rights.
2. Representations. Affiant represents that, to Affiant's knowledge, there is no existing final court order adjudicating paternity of the child; Affiant has not been adjudicated by a court of competent jurisdiction as not the biological parent; and Affiant has provided truthful information in this affidavit.
3. Legal Effect and Use. Affiant understands that this affidavit may be relied upon by governmental entities, vital records agencies, courts, and other parties for the purpose of establishing paternity and that such reliance may result in the issuance or amendment of a birth certificate or the initiation of support or parental rights proceedings.
4. Consent to Genetic Testing. Affiant acknowledges that any party named or affected by this affidavit may request genetic testing under applicable law and that results of such testing may rebut or confirm the assertions contained herein. Affiant consents to the release of genetic test results to courts and relevant administrative agencies.
5. Obligations. Affiant understands that by acknowledging paternity Affiant may incur legal duties including, but not limited to, child support, health care obligations, and obligations concerning custody and visitation, and that such duties may be enforced by appropriate authorities.

AFFIANT INFORMATION

CHILD INFORMATION

Child Place of Birth:   Hospital or Facility (if known):

ACKNOWLEDGMENT AND OATH

I, the Affiant named above, declare under penalty of perjury under the laws of the jurisdiction named below that the facts set forth in this affidavit are true and correct. I understand that knowingly making a false statement in a sworn affidavit may subject me to criminal penalties and civil liability.

Jurisdiction (State):   Date of Oath:

REPRESENTATIONS, WARRANTIES, AND CONSENTS

Affiant represents and warrants that Affiant has the legal capacity to execute this affidavit, that the statements contained herein are made voluntarily, and that Affiant consents to the use of this affidavit by governmental and judicial entities as evidence of paternity. Mother acknowledges that she has been informed that this affidavit may be used to establish paternity and has the opportunity to seek legal advice prior to executing any related documents.

NOTICES

Any notice or communication required or permitted under this affidavit shall be in writing and delivered to the address provided for each party. Notice is effective upon personal delivery or three business days after deposit in the United States mail, postage prepaid, addressed to the most recent address on file.

MISCELLANEOUS

Governing Law: This affidavit shall be governed by and construed in accordance with the laws of the jurisdiction named in the Jurisdiction (State) field above without regard to conflict of law principles.

Entire Agreement: This affidavit constitutes the entire written agreement and understanding of the parties with respect to the subject matter contained herein and supersedes all prior and contemporaneous oral and written statements and agreements.

Severability: If any provision of this affidavit is held to be invalid or unenforceable, the remainder of this affidavit shall remain in full force and effect and shall be interpreted so as to reasonably effect the intent of the parties.

Amendments and Waiver: No amendment, modification, or waiver of any provision of this affidavit shall be effective unless in writing and signed by both parties. The failure to enforce any provision shall not constitute a waiver of future enforcement of that or any other provision.

Counterparts: This affidavit may be executed in one or more counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

NOTARY INFORMATION (FOR OFFICIAL USE)

Notary Name:   Commission No.:

Commission Expiration:

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