Affidavit Of Parentage {CV-604}

Court File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court DivisionName Of Plaintiff (Or Mother) VERSUS AFFIDAVIT OF PARENTAGE Name Of Defendant (Or Father) G.S. 110-132Name And Address Of Father Name And Address Of Mother Fathers DOB Race Fathers Social Security No. Maiden Name Of Mother Birthplace Of Father (County And Mothers Social Security No. State) Date Of Birthplace Name Of Child(ren) Birth (County And State) NOTICE Signing this document may impose substantial legal obligations upon you. If you do not fully understand these obligations, you may consult a lawyer, at your own expense, before signing. Providing false or inaccurate information on this document may result in criminal penalties against you. Unless rescinded, this document constitutes an admission of paternity and has the same legal effect as a judgment of paternity for the purpose of establishing your legal duty to support the above-named children. This document may be rescinded by the child(ren)s mother or the putative father (a) within sixty (60) days of the date this document is executed, or (b) before entry of an order establishing paternity or an order for the payment of child support, whichever is earlier. To rescind this document, you must file a request for rescission with the Clerk of Superior Court and request a hearing before the district court within the time period indicated above. After sixty (60) days have elapsed, execution of this document may be challenged in court only upon the basis of fraud, duress, mistake, or excusable neglect. FATHERS ACKNOWLEDGMENT I, the undersigned , beong duly sworn, freely and voluntarily declare and acknowledge that I am the natural father of the child(ren) named herein, and that the information regarding myself, the natural mother, and the minor child(ren) is true and correct to the best of my knowledge, information and belief. Date SWORN AND SUBSCRIBED TO BEFORE ME Date Signature Of Person Authorized To Administer OathsSignature Of Natural Father Deputy CSC Assistant CSC Clerk Of Superior Court Date My Commission Expires SEAL Notary AOC-CV-604, Rev. 7/2001 1999 Administrative Office of the Courts (Over) American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 MOTHERS AFFIRMATION I, the undersigned, being dulysworn, declare and affirm that: 1. I am the mother of the above-named child(ren); 2. the above-named father is the father of the above-named child(ren); and 3. the above information regarding myself, the father, and the minor child(ren) is true and correct to the best of my knowledge, information, and belief. I also declare and affirm that I was not married was married when the above-named child(ren) was/were born. NOTE: If you were married to someone other than the above-named father at the time you became pregnant or when the child(ren) was born, you must provide additional evidence (e.g., affidavit from your husband or court order) that your husband is not the child(ren)s father. Date SWORN AND SUBSCRIBED TO BEFORE ME Date Signature Of Person Authorized To Administer Oaths Signature Of Mother Deputy CSC Assistant CSC Clerk Of Superior Court Date My Commission Expires SEAL Notary AOC-CV-604, Side Two, Rev. 07/2001 l999 Administrative Office of the Courts American LegalNet, Inc. www.USCourtForms.com