Cse 1016Aforpd Form – Fill Out and Use This PDF

WAIVER OF PATERNITY AFFIDAVIT

(THIS IS A LEGAL DOCUMENT, PLEASE TYPE OR PRINT IN BLACK INK.)

		AFFIDAVIT OF PRESUMED FATHER
STATE OF	)
			ss.
	)			AFFIDAVIT
County of	)

I,			, being duly sworn upon my oath, depose and say:
	(Presumed Father's Name - First, Middle, Last)
that I am the former/present husband of				and that at the time of conception of:
		(Name of Child's Mother - First, Middle, Last)

Child 1 Name (First, Middle, Last)

Child 2 Name (First, Middle, Last)

Child 3 Name (First, Middle, Last)

I was married to

, but did not have sexual access to her during the conception period(s).

(Name of Child's Mother - First, Middle, Last)

Therefore, I am not the natural father of the above-named child(ren) and hereby relinquish and waive all legal rights that I might have to the above-named minor child(ren).

Further, I do not object to any proceeding to establish paternity against the natural father. I waive my right to notice of and my right to appear at any hearing for the above-named child(ren).

Dated:

Signature:

Subscribed and sworn or affirmed and acknowledged before me this date:

My Commission Expires:		Notary Public

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