Fill and Sign the Mississippi Stipulated Agreement Form

IN THE CHANCERY COURT OF       COUNTY, MISSISSIPPI       JUDICIAL DISTRICT DEPARTMENT OF       STATE OF MISSISSIPPI VS. NO.             SSN:       STIPULATED AGREEMENT OF SUPPORT AND ADMISSION OF PATERNITY STATE OF MISSISSIPPI COUNTY OF       THIS DAY respondent personally came and appeared before me, the undersigned authority, who having been by me first duly sworn states on oath the following: 1. That I,       , am a resident citizen of       County, Mississippi and reside at the following address:       ,       , MS       . 2. That this Stipulated Agreement of Support and Admission of paternity is executed by me for the express purposes of admitting and legally acknowledging in writing that I am the natural father of the following named child. 3. That       , a resident of       County, Mississippi is the mother of my child named below; that on or about       , we began going together, and as result of our relationship the following named minor child, of which I am the father, were born out of wedlock: NAME DATE OF BIRTH             4. That I understand that I am legally obligated to support my child pursuant to section 43 - 19 - 33 of the Mississippi Code Ann., as amended and hereby agree to pay the sum of $       per month in child support beginning on the       day of       ,       , and continuing thereafter each month in a like manner until all children become emancipated. My adjusted gross income is $       . 5. All child support payments and fees associated with the payment of child support should be paid to the Department of       in care of the       County Department of       , P 0 BOX       ,       , MS       . 6. That I,       , hereby agree/do not agree to give security by bond or other security approved by the Court to guarantee the payment of future child support in the amount of $       , within 30 days. 7. I agree/do not agree to provide health insurance for my child. I will/will not provide the Department with health insurance policy information, including the name of the insurer, policy number, costs, effective date of coverage for the child, any insurance card needed to obtain service from a provider within thirty (30) days of the date this agreement is approved by the court. I agree to keep the Department informed of any change in health insurance availability. 8. I understand and agree that the Court shall enter a separate Order for Withholding against me as the Obligor, which shall take effect immediately. I agree to keep the Department informed of the name and address of my current employer or any new or additional employer, and to provide this information to the Department within five days of employment with a new or additional employer. 9. I agree to pay all court costs in this Civil Action, said costs to be paid directly to the Clerk of the Court, within 30 days of filing this instrument. 10. I understand that this agreement, when approved by the Court, shall have the same force and effect as an Judgment of Paternity, and it is enforceable and subject to modification in the same manner as is provided by law for orders of the Court in such cases. Submitted this the       day of       ,       _______________________________________ RESPONDENT SWORN T0 AND SUBSCRIBED BEFORE ME, this the       day of       , 20       . _________________________________________ NOTARY PUBLIC (SEAL) My Commission expires: