Fill and Sign the Rules Vital Events Mississippi Secretary of State Form

IN THE CHANCERY COURT OF COUNTY, MISSISSIPPI , A MINOR, BY , MOTHER AND NEXT FRIEND BY , NEXT FRIEND VS. NO. AFFIDAVIT BLOOD TESTING RESULTS STATE OF MISSISSIPPI COUNTY OF I, , Ph.D., having been duly sworn under oath state the following: 1. By order of the Chancery Court of County, Mississippi, entered in Civil Action File No. on the day of , , I was authorized and appointed to perform all necessary blood tests on the following individuals for the purpose of reasonably proving or disproving the probability of the Alleged Father's paternity of the child set forth below: (a) the mother, (b) the Alleged Father, (c) and the child, 2. NAME My full name is: . 3. ADDRESS My address is , , MS . 4. TELEPHONE My telephone number is . 5. QUALIFICATIONS My qualifications are as follows, to wit: 6. EDUCATION My education is as follows, to wit: 7. EXPERIENCE My experience is as follows to wit: 8. IDENTIFICATION OF INDIVIDUALS The mother, Alleged Father, and child were identified when the samples were drawn as follows, to wit: 9. WHO DREW TEST SAMPLES The test samples were drawn by: 10. HOW THE TEST SAMPLES WERE DRAWN The test samples were drawn as follows, to wit: 11. WHEN THE TEST SAMPLES WERE DRAWN The test samples were drawn as follows, to wit: 12. WHERE TEST SAMPLES WERE DRAWN Test samples were drawn at the following location, to wit: 13. CHAIN OF CUSTODY The chain custody of the test samples from the time drawn until the tests were completed is as follows, to wit: 14. RESULTS OF TEST The results of the tests are as follows, to wit: is excluded as the father of . 15. PROBABILITY OF PATERNITY The Alleged Father's probability of paternity of the child, as calculated by an expert based on test results is as follows, to wit: The probability of paternity is %. 16. AMOUNT OF FEE The amount of the fee for performing the test is as follows, to wit: The standard fee for paternity testing is $ . 17. PROCEDURES PERFORMED Procedures performed to obtain test results are as follows, to wit: ___________________________________ Affiant Sworn and subscribed before me, this the day of , 20 . _________________________________________ Notary Public My Commission expires: _________________________________