Parentage Questionnaire {DEP025}

SUPERIOR COURT OF CALIFORNIACOUNTY OF LOS ANGELESPARENTAGE QUESTIONNAIREREAD THE FOLLOWING BEFORE YOU FILL OUT THIS FORM: Because you are signing this form under penalty of perjury, your answers have the same effect as testimony beforethe court and you are legally obligated to tell the truth. You should talk with your attorney before 336 lling out this form.If you want an attorney to represent you and one has not yet been appointed, let the court know before you 336 ll outthis form. This form may be provided to the Child Support Division for the purposes of obtaining support for the child.CHILD222S NAME: BIRTHDATE: PARENTAGE INQUIRY1. Who do you believe to be the parent of this child? (Complete separate form for each different parent.)Name: Birthdate: 2. (A) Was father present at the child222s birth? Yes/No (B)Did he sign the birth certi336 cate, or other paperwork naming him the father? Yes/No 3. Are parents married? Date Divorced (Date) Separated (Date) 4. (A) Were parents married at the time of the child222s conception and birth? Yes/No (B)Were parents living together at the time of the child222s conception and birth? Yes/No (C)Was mother living with someone other than the man she named as father, at time of conception?Yes/No (D)Was either parent living in a registered domestic partnership home? Yes/No 5. (A) Has the parent held him/herself out openly as the parent? Yes/No (B) Has the parent received the child in his/her home? (Inquire if parent is helping to support336 nancially, paying rent, buying necessities, and having a relationship with the child.) Yes/No 6. (A) Has a paternity test been done? Yes/No Results (B) Has any other court or agency declared paternity?Child Support Division Family Law Court 7.A) Is/Was mother married to someone other than the person she has named as the other parent?Yes/No Name Date of Marriage? Divorced? (Date) 8.How can we locate parent? 9.Other I declare under penalty of perjury under the laws of the State of California, that the foregoing is true andcorrect, and that this declaration is executed at Monterey Park, California.Signature of Mother Date FOR COURT USE ONLY COURT FINDS: Following Parent 002Alleged002Declared Biological CRC 5.635 (e) (3)002Presumed:002JV 505002FC 002Family Law Court002Hospital Declaration002Child Support Division002MarriageDate: Superior CourtPink - Attorney Yellow - Parent/Caretaker Green - County Counsel Goldenrod - CSW Distribution:Original - Court American LegalNet, Inc. www.FormsWorkFlow.com