Commonwealth of Massachusetts
The Trial Court Probate and Family Court Department
COMPLAINT TO ESTABLISH PATERNITY
, Plaintiff 1. Plaintiff, who resides at
(Street Address) (State) (Zip) (City/Town) (County)
, is father custodian of a child born out of wedlock. of a child born out of wedlock. of the mother father of a child born out of wedlock. agency licensed under G.L. c. 28A.
the the the the
mother guardian parent
a child born out of wedlock. personal representative
Department of Social Services
the Department of Revenue. 2. The child who is the subject of this complaint is: Name
Date of Birth
(City/Town) (Street Address) (City/Town) (State) (Zip) (County)
3. Defendant, who resides at , is the mother father of the above-named child who was born out of wedlock.
4. The plaintiff and defendant are not married. 5. The mother of the child was not married at the time of the child's birth and was not married within three hundred days before the birth of the child. 6. Wherefore, the plaintiff requests that the Court: adjudicate the order the grant the grant the Date
(Signature of attorney or plaintiff, if pro se) (Print name)
plaintiff plaintiff plaintiff plaintiff
defendant to be the father of the child. maintain provide health insurance for the benefit of the child. plaintiff and/or the child.
order a suitable amount of support for the child. defendant to prohibit the defendant from imposing any restraint on the personal liberty of the defendant custody of the child. defendant parenting time with the child.
CJ-D 106 (10/07)