Fill and Sign the Petition Acknowledgment Form

__________________ NUMBER: ____ , DIVISION: ____ THE FAMILY COURT VERSUS PARISH OF ________________ __________________ STATE OF LOUISIANA PETITION TO RESCIND ACT OF ACKNOWLEDMENT NOW INTO COURT, through undersigned counsel, comes petitioner _________________ , a major person domiciled in __________ Parish, State of Louisiana, who respectfully represents: 1. Made defendant herein is _________________ , a major person domiciled in the Parish of __________ and natural mother of the minor child _________________ (hereafter the child), born __________ ___ , 20 ___ . 2. Petitioner shows that on or about __________ ___ , 20 ___ he executed an affidavit acknowledging paternity of the child and caused his name to be placed on the child’s birth certificate as the child’s father. 3. Petitioner shows that the execution of the affidavit and all actions arising there from were undertaken in reliance upon defendant’s representation that he was the natural father of the child, and he would not have executed the affidavit at issue if he had not been told by defendant that he was the father of the child. 4. Petitioner shows that on __________ ___ , 20 ___ a paternity test was conducted by _________________ , and as shown by the copy of the results attached hereto as Exhibit 1, it was conclusively proven that petitioner is not the biological father of the child. 5. Because petitioner has never been married to the defendant, and thus no presumptions arise as to paternity, petitioner desires and is entitled to rescind the acknowledgment of paternity entered into, as provided for in Article 206 of the Louisiana Civil Code. WHEREFORE, petitioner prays that there be judgment herein rescinding his act of acknowledging paternity and ordering that his name be removed from the child’s birth certificate. RESPECTFULLY SUBMITTED BY: _________________________________ __________________ ATTORNEY AT LAW _________________ __________ , LA _______ Ph. _________________ Bar Roll No. __________ PLEASE SERVE : Hold Service - Waiver to Follow