"Affidavit of Nonpaternity" - Montana

Affidavit of Nonpaternity is a legal document that was released by the Montana Department of Public Health and Human Services - a government authority operating within Montana.

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Download "Affidavit of Nonpaternity" - Montana

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AFFIDAVIT OF NONPATERNITY
OFFICE OF VITAL RECORDS
PO BOX 4210
HELENA MT 59604
406-444-2685
I,
, being duly sworn, deposes and says that:
I was married
Husband's Name
To
on________________________ in _________________,
Wife's Name
Date of Marriage
City
.
My wife gave birth to a ______________ child in
,
State
Sex
City
On
.
The name of the child is
County
Date of Birth
. I now state that although legally married at the
Child's Name
time of this birth, I am not the father of the named child. I request that my name not
be listed on the birth certificate.
_______________________________________
Husband’s Signature
_______________________________________
Street Address
_______________________________________
Verification of Signer’s ID is Mandatory
City, State and Zip Code
State of:________________________
County of:______________________
This record was signed and sworn to(or affirmed) before me on __________________by
(Date)
___________________________
(Name of Applicant)
___________________________
(Notary’s Signature)
[Official Stamp]
=============================================================================
I,
, am the mother of
and
Mother's Name
Child's Name
I state that I was legally married at the time of the birth. My husband as listed is
not the father of the above named child and I request that his name not be listed
on the birth certificate.
_____________________________________
Wife’s Signature (Mother)
_______________________________________
Street Address
_______________________________________
Verification of Signer’s ID Is Mandatory
City, State and Zip Code
State of:________________________
County of:______________________
This record was signed and sworn to (or affirmed) before me on _________________ by
(Date)
_________________________
(Name of Applicant)
_________________________
(Notary’s Signature)
[Official Stamp]
Print Form
Clear Form
AFFIDAVIT OF NONPATERNITY
OFFICE OF VITAL RECORDS
PO BOX 4210
HELENA MT 59604
406-444-2685
I,
, being duly sworn, deposes and says that:
I was married
Husband's Name
To
on________________________ in _________________,
Wife's Name
Date of Marriage
City
.
My wife gave birth to a ______________ child in
,
State
Sex
City
On
.
The name of the child is
County
Date of Birth
. I now state that although legally married at the
Child's Name
time of this birth, I am not the father of the named child. I request that my name not
be listed on the birth certificate.
_______________________________________
Husband’s Signature
_______________________________________
Street Address
_______________________________________
Verification of Signer’s ID is Mandatory
City, State and Zip Code
State of:________________________
County of:______________________
This record was signed and sworn to(or affirmed) before me on __________________by
(Date)
___________________________
(Name of Applicant)
___________________________
(Notary’s Signature)
[Official Stamp]
=============================================================================
I,
, am the mother of
and
Mother's Name
Child's Name
I state that I was legally married at the time of the birth. My husband as listed is
not the father of the above named child and I request that his name not be listed
on the birth certificate.
_____________________________________
Wife’s Signature (Mother)
_______________________________________
Street Address
_______________________________________
Verification of Signer’s ID Is Mandatory
City, State and Zip Code
State of:________________________
County of:______________________
This record was signed and sworn to (or affirmed) before me on _________________ by
(Date)
_________________________
(Name of Applicant)
_________________________
(Notary’s Signature)
[Official Stamp]
Print Form
Clear Form