Alaska > Statewide > Child Support Services Division
Affidavit In Support Of Establishing Paternity 0970-0085 - Alaska
| Affidavit In Support Of Establishing Paternity Form. This is a Alaska form and can be used in Child Support Services Division Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
AFFIDAVIT IN SUPPORT OF ESTABLISHING PATERNITY Petitioner: Name (first, middle, last) Social Security Number IV-D Case: Respondent: Name (first, middle, last) Social Security Number Non-IV-D Case: [ [ [ [ [ [ ] ] ] ] ] ] TANF IV-E Foster Care Medicaid Only Former Assistance Never Assistance File Stamp Responding IV-D Case Identifier Responding Tribunal Number Initiating IV-D Case Identifier Initiating Tribunal Number A Separate Affidavit Is Required for Each Child Needing Paternity Established. SEC TI N 1 O I, Name (first, middle, last) 1. I am the [ ] natural mother of the child named below: [ ] natural father [ ] other; explain in Section IV (first, middle last) (Month, Day, Year) , on oath, under penalty of perjury depose and allege: Place of Birth (City, County, State) Date Mother Got Pregnant (Month, Year) Full Term Pregnancy [ ] Yes [ ] No (If No, explain) Where Mother Got Pregnant (City, County, State) (first, middle, last) 2. The child was conceived as a result of sexual intercourse between and me during the time stated above. Name (first, middle, last) [ ] Yes (Attached certified copy) [ ] No 3. a. b. occurred within a year of the end of the marriage. [ ] Yes [ ] No Date marriage ended (Month, Day, Year) c. A man signed an acknowledgment of paternity before an acknowledgment became a legal finding of paternity under State law. . [ ] Yes (Attached certified copy) [ ] No d. [ ] Yes [ ] No e. Genetic tests were completed to determine the biological father of the child. If Yes, attach results. [ ] Yes [ ] No Affidavit in Support of Establishing Paternity OMB 0970 0085 Expiration Date: 05/31/2014 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT IN SUPPORT OF ESTABLISHING PATERNITY, PAGE 2 SECTION II (TO BE COMPLETED BY MOTHER ONLY) 1. I had sexual intercourse with another during the time 30 days before or 30 days after the child was conceived. Initiating IV-D Case Identifier [ ] Yes [ ] No (If Yes, complete the following). a. The name(s) and address(es) of the other man/men: b. [ ] Yes c. [ ] No. If Yes, explain the biological relationship r. (e.g., brother, cousin, uncle, etc.) I do not believe the other man/men is/are the father because: 2. a. [ ] Yes [ ] No (If Yes, complete the following) b. Explain why the husband is not the father of this child and attach all appropriate documents, including divorce decree, genetic test results and prior findings of non-paternity, if any: 3. a. b. c. d. e. Name (first, middle, last) We lived together. is the father of this child. The following facts support my allegations of paternity: [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] No [ ] No [ ] No [ ] No Dates: Location To I have told welfare officials that he is the father of this child. I told him that he was the father of the child. He is named as the father on the birth certificate. He signed an acknowledgment of paternity before an acknowledgment became a legal finding of paternity under State law. He admitted being the father of the child. He sent cards/letters regarding the pregnancy and/or about the child. He was present at the birth of the child. He visited the child at the hospital following birth He offered to pay abortion expenses. He offered to pay medical expenses. He paid for birth related expenses. He claimed the child on tax returns. He has provided food, clothing, gifts or financial support for the child. He lived with the child. He visited the child. The child resembles him. [ ] Photo attached There are witnesses to my relationship with him. [ ] Certified Copy Attached [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] No [ ] No [ ] No [ ] No [ ] No [ ] No [ ] No [ ] No [ ] No [ ] No [ ] No [ ] No [ ] No [ ] No [ ] Certified Copy Attached f. g. h. i. j. k. l. m. n. o. p. q. r. [] Copies Attached If Yes, explain in Section IV If Yes, explain in Section IV If Yes, explain in Section IV If Yes, explain in Section IV (If Yes, list names and addresses and briefly describe relevant facts known by each under Section IV) Affidavit in Support of Establishing Paternity Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT IN SUPPORT OF ESTABLISHING PATERNITY, PAGE 3 SECTION III (TO BE COMPLETED BY FATHER ONLY) The following facts support my belief and statements that I am the father of this child: a. b. c. d. The mother and I lived together. The mother told me that I am the father of the child. I am named as the father on the birth certificate. I signed an acknowledgment of paternity before an acknowledgment became a legal finding of paternity under State law. I was present at the birth of the child. I visited the child at the hospital following birth I offered to pay abortion expenses. I offered to pay medical expenses. I paid for birth related expenses. I claimed the child on tax returns. I have provided food, clothing, gifts or financial support for the child. I lived with the child. I visited the child. The child resembles me. [ ] Photo attached There are witnesses to my relationship with the [ ] Yes [ ] Yes [ ] Yes [ ] Yes Initiating IV-D Case Identifier [ ] No [ ] No [ ] No [ ] No Dates: Location To [ ] Certified Copy Attached [ ] Certified Copy Attached e. f. g. h. i. j. k. l. m. n. o. [ [ [ [ [ [ ] ] ] ] ] ] Yes Yes Yes Yes Yes Yes [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] No No No No No No No No No No If Yes, explain in Section IV If Yes, explain in Section IV If Yes, explain in Section IV If Yes, explain in Section IV [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] Yes [ ] No (If Yes, list names and addresses and briefly describe relevant facts known by each under Section IV) SECTION IV OTHER PERTINENT INFORMATION in Section II or Section III above) [] Continued On Attached Sheet(s), incorporated by reference. All of the information and facts contained in this AFFIDAVIT IN SUPPORT OF ESTABLISHING PATERNITY are true and correct to my best knowledge and belief. I agree to submit myself and, if I am the custodian, my child to genetic testing as may be necessary to establish paternity. Date Signature Sworn to and Signed before me this Date, County and State Notary Public/Official and Title Commission Expires Affidavit in Support of Establishing Paternity Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
