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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(a)(3), AFFIDAVIT OF NONPATERNITY When should this form be used? This form should be used when a stepfather is adopting his wife's minor child and the mother and father of the minor child(ren) were never married and paternity has not been established by a valid acknowledgment or court order. This Affidavit of Nonpaternity may be used instead of a consent form. This Affidavit may be executed before the birth of the minor child. The person signing the affidavit waives notice to all court proceedings after the date it is signed. After signing this affidavit, it may only be withdrawn if the court finds the affidavit was obtained by fraud or duress. This form should be typed or printed in black ink. This form must be signed before a notary public or deputy clerk and two witnesses other than the notary or clerk. You should then file the original of this form with the Petition for Stepparent Adoption, O` Florida Supreme Court Approved Family Law Form 12.981(b)(1). Remember - a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, O` Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.

Instructions for Florida Supreme Court Approved Family Law Form 12.981(a)(3), Affidavit of Nonpaternity (03/04)

IN THE CIRCUIT COURT OF THE IN AND FOR

JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division:

IN THE MATTER OF THE ADOPTION OF

, Adoptee(s).

AFFIDAVIT OF NONPATERNITY I, {full legal name} , have personal knowledge of the facts stated in this affidavit and certify that the following statements are true: 1. I have been told that {name} has a child. I do not wish to and and shall not establish or claim paternity for this child, whose name is whose date of birth is . The child referenced in this affidavit was not conceived or born while the birth mother was married to me. I AM NOT MARRIED TO THE BIRTH MOTHER, nor do I intend to marry the birth mother. The child has not been established to be my child in any court proceeding and I have not adopted this child. I have no interest in assuming the responsibilities of parenthood for this child. I have not acknowledged and will not acknowledge in writing that I am the father of this child or will not institute court proceedings to establish the child as mine. I do not object to any decision or arrangements the birth mother makes regarding this child, including adoption. I understand my right to choose a person who does not have an employment, professional, or personal relationship with the adoption entity or the prospective adoptive parents to be present when this affidavit is executed and to sign it as a witness. The witness I selected is . {full legal name} I am executing this affidavit freely and voluntarily and I understand that it can only be withdrawn if the court finds it was executed by fraud or duress.

2.

3. 4.

5. 6.

7.

I WAIVE NOTICE OF ANY AND ALL PROCEEDINGS TO TERMINATE PARENTAL RIGHTS OR FINALIZE AN ADOPTION UNDER CHAPTER 63, FLORIDA STATUTES.

Florida Supreme Court Approved Family Law Form 12.981(a)(3), Affidavit of Nonpaternity (03/04)

I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this consent and waiver and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Signature
Printed Name: Address: City, State, Zip:

Signature of Witness Printed Name: Business Address: Home Address: Driver's License or State ID Card No.:

Signature of Witness Printed Name: Business Address: Home Address: Driver's License or State ID Card No.:

STATE OF FLORIDA COUNTY OF Sworn to or affirmed and signed before me on {date} at {time} .

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of notary or deputy clerk.] Personally known Produced identification Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ N fill in all blanks] I, {full legal name and trade name of nonlawyer} , a nonlawyer, located at {street} , {city} , {state} , {phone} , helped {name} , who is the affiant, fill out this form.

Florida Supreme Court Approved Family Law Form 12.981(a)(3), Affidavit of Nonpaternity (03/04)