Fill and Sign the Stipulated Agreement 497314630 Form

IN THE CHANCERY COURT OF       COUNTY, MISSISSIPPI       DISTRICT       PLAINTIFF VS. NO.             DEFENDANT 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:       . 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       , 20       , and continuing thereafter each month in a like manner until all children become emancipated. My adjusted gross income is $       . All child support payments and fees associated with the payment of child support should be paid to       in care of the       ,       ,       , MS       . 6. That I,       , hereby agree to give security by bond or other security approved by this court to guarantee the payment of future child support in the amount of $       , within       days. 7. I agree do not agree to provide health insurance for my child. I will/will not       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       (       ) 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       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       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       , 20       . _________________________________________ RESPONDENT SWORN TO AND SUBSCRIBED BEFORE ME, this the       day of       , 20       . (SEAL) _________________________________________ Notary Public MY COMMISSION EXPIRES:       STATE OF MISSISSIPPI COUNTY OF       AFFIDAVIT AND AFFIRMATION OF PATERNITY THIS DAY PERSONALLY CAME AND APPEARED BEFORE ME, the undersigned authority in and for the aforesaid jurisdiction, the within named       , who first having been by me duly sworn, states on oath the following: 1. That this Affidavit is made upon information that is within my personal knowledge and my belief thereof; 2. That I am competent to swear to the matters stated herein; 3. That I do execute this Affidavit and Affirmation of Paternity for the specific purpose of complying with Section 43 - 19 - 33 et. seq. of the Mississippi Code (1972), as amended; and other applicable Statutes and Regulations; 4. That I have read and do understand the statements made herein and further state that I do freely and voluntarily make and execute this Affidavit under penalty of perjury; 5. That       is the natural father of my child, whose full name and date of birth are listed below, and that as a result of our relationship they were born out of wedlock: NAME       BIR THDATE       /       /       6. That I am not aware of any previous paternity action in which was rendered a judgment of paternity involving my child and myself listed above. _________________________________ AFFIANT SWORN TO AND SUBSCRIBED before me on this the       day of       A. D.,       . _________________________________ NOTARY MY COMMISSION EXPIRES:       CASE NO.       STATE OF MISSISSIPPI COUNTY OF       AFFIDAVIT ADMISSION OF PATERNITY THIS DAY personally came and appeared before me, the undersigned Notary Public, in and for the aforesaid jurisdiction, the within named       who first having been duly sworn, states on oath the following: That I,       , the undersigned, residing at, in of my own free will and accord do hereby admit and acknowledge in writing that I am the natural father of the child as named herein below; that on or about       /       /       ,       and I started living together/going together, and as a result of our relationship the following named child was born out of wedlock: NAME       BIRTHDATE       /       /       I hereby execute this Affidavit for the purpose of admitting paternity of my child. _______________________________ AFFIANT SWORN TO AND SUBSCRIBED before me on this the       day of       ,       . __________________________ NOTARY MY COMMISSION EXPIRES: