Form 5-1 Paternity Petition | Family Law Vault

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Form 5-1 Paternity Petition - Individual

Step 1 of 9

Case Information

County Name Docket Number Petitioner Name Respondent Name

1. Petitioner Role

I am the birth mother of the child and request an order declaring Respondent to be the father I am pregnant with the child and request an order declaring Respondent to be the father I am the father of the child and request an order declaring me to be the father Upon information and belief, I may be the father and request an order determining paternity

2. Residence and Intercourse Period

Petitioner Residence Address Respondent Residence Address Beginning Day Beginning Month Beginning Year Ending Day Ending Month / Year

3. Child or Pregnancy Information

Who gave birth? Child Name Child Gender Child Date of Birth Who is now pregnant? I am requesting an order for genetic testing

4. Mother’s Marital Status at Conception

At the time of conception, the mother: Mother’s Spouse Name, if married Spouse Last Known Address

5. Acknowledgment of Parentage

I have acknowledged parentage I acknowledged parentage in writing I acknowledged parentage by furnishing support Respondent acknowledged parentage Respondent acknowledged parentage in writing Respondent acknowledged parentage by furnishing support Existing Adjudication or Acknowledgment Exception

6. Child Support Services and ICWA

Child Support Services Selection Subject child may be a Native American child subject to ICWA? Previous Application Exception

7. Signature Section

Upload Signature Image Print or Type Name Attorney Signature, if any Attorney Name Attorney Address and Telephone Number Dated Month Dated Day Verification Day Verification Month Verification Year Verification Signature Name

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