Louisiana Form Paternity PDF Details

In Louisiana, the establishment of paternity is a process endowed with legal gravitas, implicating a gamut of rights and responsibilities for the parties involved. Central to this process is the "Acknowledgement of Paternity Affidavit," a document that stands as a testament to the recognition of a biological link between a father and his child, particularly in instances where the child is born out of wedlock or situations where paternity is questioned or contested. Beyond the mere assignment of a father’s name to the child’s birth certificate, the affidavit serves as a pivotal cornerstone enabling the child to inherit, access medical history from both parents, and qualify for benefits such as health care coverage and social security. Notably, the affidavit outlines explicit provisions for both parents, detailing an extensive admonition regarding the voluntary nature of this acknowledgment, the irrevocable legal standing upon signing, and the consequential right to rescind under specific conditions. Additionally, the form addresses particular scenarios where the mother might be married to or recently divorced from another man, underscoring the necessity of his concurrence for the affidavit’s execution or a requisite legal establishment of paternity through court intervention. This comprehensive document, hence, ensures that each parent is cognizant of the alternatives, rights, and responsibilities that crystallize with the acknowledgment of paternity, reinforcing the premises of legal and emotional welfare for the child in question.

QuestionAnswer
Form NameLouisiana Form Paternity
Form Length2 pages
Fillable?No
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Avg. time to fill out30 sec
Other namesaknowledgement of paternity louisiana, affidvant of acknowlegment of partinety louisiana, acknowledgement affidavit, acknowledgment of paternity affidavit

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STATE OF LOUISIANA

ACKNOWLEDGMENT OF PATERNITY AFFIDAVIT

CHILD BORN OF MARRIAGE

NOTICE: You must read and initial the NOTICE OF ALTERNATIVES, RIGHTS AND RESPONSIBILITIES before you sign the affidavit.

 

 

 

SECTION I. CHILD'S INFORMATION

 

 

 

 

 

This is a legal document. Complete in ink and do not alter.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Child - First, Middle, Last (As it appears on birth certificate)

 

 

 

Date of Birth - (Month, Day, Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Place of Birth - City, State

 

 

 

 

 

 

 

Name of Hospital

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Child - First, Middle, Last (As the parents want it to appear on birth certificate)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION II. MOTHER'S INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

husband.-

 

 

Name of Mother - First, Middle, Last

 

 

 

 

 

(Maiden Name)

 

Date of Birth - (Month, Day, Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mother's Address

 

 

 

 

 

 

 

 

 

 

 

Mother's Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ex

 

 

Mother's Place of Birth - City, State

 

 

 

Race (Circle) American Indian, Black, White, Asian

 

Mother's Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Other, List:

 

 

 

 

 

 

 

 

 

Husband/&

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Circle One:

Yes

No

 

 

 

 

 

 

Mother's Occupation

 

 

 

 

 

 

 

Mother's Employer - Name & Address

 

 

 

 

 

 

 

 

 

 

 

 

 

Was Mother Married at Time of Birth

If Yes, Name and Address of Husband

 

 

 

 

 

 

 

Father

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does Mother Have Health Insurance

If Yes, Name of Insurance Company and Policy No.

 

State Medicaid:

 

 

 

 

 

Circle One:

Yes

No

 

 

 

 

 

 

 

Circle One:

 

Yes

No

 

Mother,

 

 

SECTION III. FATHER'S INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Father - First, Middle, Last

 

 

 

 

 

 

 

Date of Birth - (Month, Day, Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Support,

 

 

Father's Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Father's Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Father's Place of Birth - City, State

 

 

 

Race (Circle) American Indian, Black, White, Asian

 

Father's Social Security Number

 

 

 

 

 

 

 

 

 

 

 

Childto

 

 

 

 

 

 

 

 

 

 

 

 

 

If Other, List:

 

 

 

 

 

 

 

 

 

 

 

Father's Employer - Name & Address

 

 

 

 

 

 

Father's Occupation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Copies

 

 

Father's Guardian (If Father under age 18) Print Name

Guardian's Address

 

 

Guardian's Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does Father Have Health Insurance

If Yes, Name of Insurance Company and Policy No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Records,

 

 

Circle One:

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

name appear on the Certificate of Birth of my child. I declare and affirm that I lived separate and apart from the legal presumptive father for a

minimum of one hundred

 

 

 

 

MOTHER: I certify that I am the MOTHER of the child named above and that all statements made herein are true and correct to the best

of my knowledge. I am

 

 

 

 

signing this Affidavit voluntarily and of my own free will. I acknowledge that the man named above is the biological father of my child. I give my consent to have his

Vital

 

and eighty days prior to the time of conception and have not reconciled since the beginning of the one hundred and eighty-day period.. I further acknowledge that I

 

have received oral and written notice of the legal rights and consequences resulting from my acknowledging the paternity of my child and I understand this notice.

 

 

of

__________________________________________

 

 

 

___________________________________________

 

 

 

 

Registrar

 

MOTHER'S SIGNATURE

 

 

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WITNESS ____________________________________

 

 

 

WITNESS _____________________________________

 

 

 

 

to

 

State of Louisiana, Parish of _____________________________________

______________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature then PRINT name of Notary

 

 

 

 

Original

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signed and Affirmed before me on the

 

 

day of

___________________________

_______________________

 

 

 

 

 

 

,

 

.

 

 

 

 

 

State Notary Registration Number

 

My Commission expires on

 

 

COPIES:

 

 

 

 

 

 

 

 

FATHER: I certify that I am the biological FATHER of the child named above and that all statements made herein are true and correct to the best of my knowledge. I

 

am signing this Affidavit voluntarily and of my own free will. I acknowledge that I have received oral and written notice of the legal rights and consequences resulting

 

 

 

 

 

 

 

 

from my acknowledging the paternity of my child and I understand this notice.

 

 

 

 

 

 

 

 

 

OF

__________________________________________

 

 

 

___________________________________________

 

 

 

 

 

FATHER'S SIGNATURE

 

 

 

 

 

 

 

DATE

 

 

 

 

 

 

 

DISTRIBUTION

__________________________________________

 

 

 

___________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GUARDIAN'S SIGNATURE (If Father under age 18)

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

WITNESS ____________________________________

 

 

 

WITNESS _____________________________________

 

 

 

 

 

 

 

 

State of Louisiana, Parish of _____________________________________

______________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature then PRINT name of Notary

 

 

 

 

 

 

 

 

Signed and Affirmed before me on the

 

 

day of

___________________________

_______________________

 

 

 

 

 

 

,

 

.

 

 

 

 

 

State Notary Registration Number

 

My Commission expires on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HUSBAND/EX-HUSBAND OF THE MOTHER: I certify that I was married to the mother of this child at the time of conception or birth; however, I am not the biological

 

 

 

 

father. Further, I declare and affirm that I lived separate and apart from the mother for a minimum of one hundred and eighty days prior to the time of conception and

 

 

 

 

have not reconciled with her since the beginning of the one hundred and eighty-day period.

 

 

 

 

 

 

 

 

 

 

__________________________________________

 

 

 

___________________________________________

 

 

 

 

 

 

 

 

HUSBANS/EX-HUSBAN'S SIGNATURE

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

WITNESS ____________________________________

 

 

 

WITNESS _____________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State of Louisiana, Parish of _____________________________________

______________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature then PRINT name of Notary

 

 

 

 

 

 

 

 

Signed and Affirmed before me on the

 

 

day of

___________________________

_______________________

 

 

 

 

 

 

 

,

 

 

.

 

 

 

 

 

State Notary Registration Number

 

My Commission expires on

 

 

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VRR-44 3-P 05/10

NOTICE OF ALTERNATIVES, RIGHTS AND RESPONSIBILITIES

This is a legal document. Signing the form is voluntary. Since this form has legal consequences, you may want to consult an attorney before signing.

When this Acknowledgement is properly completed and signed, the biological father's name is entered on the birth certificate in place of the name of the husband of the mother and the man becomes the legal father of the child. This acknowledgement has the same effect as a court order establishing paternity and can be used as a basis for entering a child support order.

If either of you is not sure that this man is the biological father of this child, you should not sign the form. You should have a genetic test.

Mothers who are married to someone other than the biological father or were married to someone other than the father when the child was conceived, or have been divorced for less than three hundred days must have the agreement of their husband/ex-husband to execute this affidavit. Further, the use of this affidavit is limited to cases where the husband and the mother lived separate and apart continuously for a minimum of one hundred and eighty days prior to the conception of the child and have not reconciled since the beginning of the one hundred eighty-day period. If the agreement of the husband cannot be obtained or if the couple cannot meet the statutory requirements, this affidavit cannot be used. In order for the biological father's name to be added to the birth certificate, a court must establish paternity in accordance with R.S.40:34B.(1)(a)(vii)

RIGHTS AND RESPONSIBLITIES OF A PARENT

Either party has the right to request a genetic test to determine if the alleged father is the biological father of the child.

The alleged father has the right to consult an attorney before signing an acknowledgement of paternity.

If the alleged father does not acknowledge the child, the mother has the right to file a paternity suit to establish paternity. After the alleged father signs an acknowledgement of paternity, he has the right to pursue visitation with the child and the

right to petition for custody.

Once an acknowledgement of paternity is signed, the father may be obligated to provide child support for the child.

Once an acknowledgement of paternity is signed, the child will have inheritance rights and any rights afforded children born

in wedlock.

A party who executed a notarial act of acknowledgement may rescind the act, without cause, before the earlier of the

following:

-Sixty days after the signing of the act, in a court hearing for the limited purpose of rescinding the acknowledgment.

-A court hearing relating to the child, including a child support proceeding, in which the father is involved.

Thereafter, the acknowledgement of paternity may be voided only upon proof, by clear and convincing evidence, that such act was induced by fraud, duress, or material mistake of fact, or that the father is not the biological father.

BENEFITS FOR YOUR CHILD

Every child has the right to know his or her mother and father and benefit from a relationship with both parents.

Both of your names will appear on the child's birth certificate.

It will be easier for your child to learn medical histories of both parents and to benefit from health care coverage available to you.

It will be easier for your child to receive benefits such as dependent or survivor's benefits from the Veteran's Administration or from the Social Security Administration as well as share any estate should you die.

To indicate that you have read and understood this notice of alternatives, rights and responsibilities, please initial below. If you require further assistance you may call us at (504) 593 - 5100.

Mother’s Initials ________________________

Father’s Initials ________________________

VRR-44 3-P (05/10)

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