ACKNOWLEDGMENT OF PATERNITY

(TYPE 2)

 

 

________________________________ (Name and Address) referred to as Mother, and ______________________________ (Name and Address) referred to Alleged Father, agree Mother is pregnant and is in ______ month of pregnancy. Father acknowledges paternity of this child.

 

 

_________________________                                                 ____________________

Signature of Father                                                                                          Date

 

 

_________________________                                                 ____________________

Signature of Mother                                                                                        Date

 

 

_________________________                                                 ____________________

Witness for Father                                                                                          Date

 

 

_________________________                                                 ____________________

Witness for Mother                                                                                        Date

 

 

STATE OF ______________________ COUNTY OF ________________________

On this the ____ day of _________ (Date), _____________, personally appeared before me, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

 

 

 

________________________                                    My commission expires on

Notary Public

 

STATE OF ______________________ COUNTY OF ________________________