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Back to Forms for 'Parent and Child'.





Effective as of ________________ (month & day), _____(year), by _____________

_______________ (mother's name), of ________________________________________ (address), complainant, and _______________________________________________ (Father's name), of ________________________________________________________ (Address), defendant.


The parties state that:


1.  Complainant, bore a __________ (Gender) child on ___________________ (month & day), __________ (year), at ___________________________________ (hospital address),


2.  Defendant refutes that he is the father of the child, but wants to prepare an agreement

in which he can be released from all claims having to do with the child.


3.  Complainant has heretofore filed claims against defendant in the __________________ Court of ___________, County of ____________, State of __________ claiming that Defendant is the father of her child and wanting support and maintenance of the child.


Complainant now releases defendant from all liability having to do with support or maintenance of the child.  Defendant and Complainant shall prepare an agreement in which the Defendant shall reimburse Complainant for childbirth expenses. 


_______________________________                   __________________

(Signature of Complainant)                                        (Date)

_______________________________                   __________________

(Signature of Defendant)                                            (Date)

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