This form contains 43 fields organized into 13 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Affiant and Child Identification
Affiant Name Text
Please enter the full name of the person making this affidavit.
Child's Name Text
Please enter the full name of the child mentioned in this affidavit.
Affiant's Age
Affiant's Age Number
Please provide your current age in years.
Max length: 3 characters
Affidavit Explanation Witness
Witness Name Text
Enter the name of the person who explained the affidavit.
Biological Father Identification Details
Biological Father's Name Text
Enter the full name of the biological father. Fill only if 'Know and identify biological father' is 'Yes'.
Depends on: Know and identify biological father
Biological Father's Home Address Text
Enter the last known home address of the biological father. Fill only if 'Know and identify biological father' is 'Yes'.
Depends on: Know and identify biological father
Biological Father's Work Address Text
Enter the last known work address of the biological father, including the name of the employer if known. Fill only if 'Know and identify biological father' is 'Yes'.
Depends on: Know and identify biological father
Biological Father's Age Text
Enter the current age of the biological father in years. Fill only if 'Know and identify biological father' is 'Yes'.
Max length: 3 characters
Depends on: Know and identify biological father
Date of Death - Day Text
Enter the day of the month on which the biological father died. Fill only if 'Know and identify biological father' is 'Yes'.
Depends on: Know and identify biological father
Date of Death - Year Text
Enter the year in which the biological father died. Fill only if 'Know and identify biological father' is 'Yes'.
Depends on: Know and identify biological father
Place of Death - City/Town Text
Enter the city or town where the biological father died. Fill only if 'Know and identify biological father' is 'Yes'.
Depends on: Know and identify biological father
Place of Death - County/Specific Location Text
Enter the specific location or county where the biological father died, if applicable. Fill only if 'Know and identify biological father' is 'Yes'.
Depends on: Know and identify biological father
Place of Death - State Text
Enter the state where the biological father died. Fill only if 'Know and identify biological father' is 'Yes'.
Depends on: Know and identify biological father
Biological Father's Physical Description
Race Text
Please enter the biological father's race.
Mustache/Beard Text
Please enter if the biological father has a mustache or beard, and describe it.
Hair Text
Please enter the biological father's hair color, style, or other distinguishing characteristics.
Complexion Text
Please enter the biological father's skin complexion.
Height Text
Please enter the biological father's height.
Weight Number
Please enter the biological father's weight.
Glasses Text
Please enter if the biological father wears glasses, and describe them if known.
Other Distinguishing Marks Text
Please enter any other distinguishing physical characteristics of the biological father.
Tattoos/Scars Text
Please describe any tattoos or scars the biological father has, including their type and location on the body.
Child's Birth Information
Child's Name Text
Provide the full name of the child.
Date of Birth Date
Enter the date the child was born.
Birth City Text
Enter the city where the child was born.
Max length: 4 characters
Time of Birth Time
Enter the time the child was born.
Hospital Name Text
Provide the full name of the hospital where the child was born.
Birth State Text
Enter the state where the child was born.
Child's Gender
Male Checkbox
Check this box if the child is male.
Female Checkbox
Check this box if the child is female.
Explanation for Inability to Identify Father
Explanation for Inability to Identify Father Text
Provide a detailed explanation for why you are unable to identify the biological father. Fill only if 'Do not know biological father's identity' is 'Yes'.
Depends on: Do not know biological father's identity
Father Identification Choice
Know and identify biological father Checkbox
Check this box if you know and are identifying the biological father.
Do not know biological father's identity Checkbox
Check this box if you do not know the identity of the biological father.
Unwilling to identify biological father Checkbox
Check this box if you are unwilling to identify the biological father.
General
Text27 Text
Text28 Text
Reason for Unwillingness to Name Father
Reason for Unwillingness Text
Provide the reason(s) why you do not wish to name the biological father of the child. Fill only if 'Unwilling to identify biological father' is 'Yes'.
Depends on: Unwilling to identify biological father
Residence Information
Street Address Text
Please provide the street address where you currently reside.
City or Village Text
Please provide the name of the city or village where you reside.
State Text
Please provide the name of the state where you reside.
Signature Date
Signature Date Month Date
Enter the month of the signature date.
Max length: 2 characters
Signature Date Day Date
Enter the day of the signature date.
Max length: 2 characters
Signature Date Year Date
Enter the year of the signature date.
Max length: 1 characters