Free Affidavit of Nonpaternity - Massachusetts

COMMONWEALTH OF MASSACHUSETTS AFFIDAVIT OF NONPATERNITY
THIS IS A LEGAL DOCUMENT. PRINT OR TYPE IN PERMANENT BLACK INK. We acknowledge that the husband at the time of the child's birth or within 300 days of conception is not the father of the following child:

R-134-00

First Name who was born in (Place of Birth)

Middle Name on City/Town/State

Last Name

Sex (M/F)

(Date of Birth) Month-spelled out

Day

Year

Affidavit of Mother and Presumed Father (husband at time of child's birth or within 300 days of the birth):

MOTHER
First Name Middle Name Last Name

-

-

Social Security # -

PRESUMED FATHER
First Name Born in City/State/Country CHECK ONE We, (name of mother) and were married at the time of this child's birth. We, (name of mother) from each other on and (name of presumed father) and (name of presumed father) Middle Name Last Name on

Social Security #

(Date of Birth) Month-spelled out

Day

Year

are married

were divorced

but were legally married when the child was born or within 300 days prior to the birth.

We acknowledge that the presumed father is not the father of the above-named child. We understand that we may consult an attorney. We understand that by signing this affidavit we may both be giving up certain rights if the presumed father is not named the father of the above-named child. We do not want his name to appear on the child's birth certificate. We understand that his name will appear on the birth certificate unless the mother and the child's biological father complete a Voluntary Acknowledgment of Parentage or a court judgment is issued declaring that someone else is the father. We do not object to this affidavit being filed with the court even if either of us is not present. We understand and agree that the court, based on this affidavit, may enter a judgment delcaring that another man is the child's father. The information above is true to the best of our knowledge and belief.

MOTHER
Residence:

Signature:

Date:

No & Street Address City/Town State Zip The personally appeared before me the above named __________________________________________and affirmed under penalties of perjury that the foregoing is her free act and deed this ______________day of _________________________________, _________. Form Read in ________________ Notary Public: ________________________________________My Commission Expires:________________ LANGUAGE

PRESUMED FATHER
Residence:

Signature:

Date:

No & Street Address

City/Town

State

Zip

The personally appeared before me the above named __________________________________________and affirmed under penalties of perjury that the foregoing is her free act and deed this ______________day of _________________________________, _________. Form Read in ________________ Notary Public: ________________________________________My Commission Expires:________________ LANGUAGE This affidavit must be filled with the child's birth certificate at the office of the city or town clerk located in the city or town where the child was born. Affidavit of Nonpaternity Page 1 of 2 c.g.f.

What Does It Mean If You Sign This Form? Paternity means fatherhood. For married people, the husband at the time of birth or within 300 days of the birth is presumed to be the father of a child born to his wife, and he does not have to take any further action to establish his paternity. Do not sign this form if the husband at the time of birth or within 300 days of the birth (presumed father) wants his name on the child's birth certificate. By signing this Affidavit of Nonpaternity, both the husband (presumed father) and wife are stating that the presumed father is not the legal father of the child named on this form. Since this form has legal consequences, you may want to consult an attorney before signing. The legal consequences include: * By signing this form, the presumed father gives up certain legal rights and responsibilities to be the father of the child, including the right to visitation and custody and the responsibility to support the child financially; By signing this form, the presumed father may not be required to support the child financially; By signing this form, the mother may give up the right to seek financial supprt from the presumed father and to have the presumed father's name on the child's birth certificate; Signing this form may allow the presumed father to keep his name off the child's birth certificate. Even with the signing of the form, one of the following must occur for the presumed father's name to remain off the child's birth certificate or be removed from the child's birth certificate: P The mother and biological father must complete a Voluntary Acknowledgement of Parentage; OR a court determines that someone else is the father of the child.

* *

*

P

*

If the form is not signed by the mother and the presumed father, the presumed father's name will appear on the birth certificate unless a court determines that someone else is the father; If this form is signed by the mother and the presumed father, the biological father may be allowed to place his name on the birth certificate by completing a Voluntary Acknowledgment of Parentage; and This form may be filed with the court in a subsequent proceeding to help determine whether or not the presumed father is the child's legal father. This Affidavit is not a public record. It will be available only to the presumed father, the mother, and the child named on this form, the child's legal guardian or representative, or government officials in the conduct of their official duties.

*

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Mother's Initials

Presumed Father's Initials

For questions regarding birth registration, call the Registry of Vital Records and Statistics at (617) 740-2630. For questions regarding paternity establishment, paternity testing or child support, call the Massachusetts Department of Revenue, Child Support Enforcement Division at (800) 332-2733.

Affidavit of Nonpaternity

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c.g.f.