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The Indiana Paternity Affidavit 44780 form plays a crucial role in establishing legal parentage for children born to unmarried parents. This form is designed to help ensure that both parents acknowledge their responsibilities and rights regarding their child. By completing this affidavit, parents can provide important information such as their names, addresses, and the child's details, which helps create a legal record of paternity. This process not only benefits the child by securing access to benefits like health insurance and inheritance rights but also assists parents in navigating child support and custody arrangements. Additionally, the affidavit must be signed in the presence of a notary public, which adds a layer of authenticity and legal weight to the document. Understanding the significance of the Indiana Paternity Affidavit 44780 is essential for parents looking to solidify their roles and responsibilities in their child's life.

Preview - Indiana Paternity Affidavit 44780 Form

PATERNITY AFFIDAVIT – HOSPITAL USE

State Form 44780 (R7 / 11-17)

INDIANA STATE DEPARTMENT OF HEALTH

Local Health Department Number

File Date (mm/dd/yyyy)

State File Number

 

 

 

Reset Form

Statutory Authority IC 16-37-2 Confidential: IC 16-37-1-10

PA Number

Before I signed any section of this affidavit I was allowed to review it alone and without the presence of the person listed in Section B. Also, I was given the opportunity to consult with an adult of my choosing.

Signature of Mother

Before I signed any section of this affidavit I was allowed to review it alone and without the presence of the person listed in Section C. Also, I was given the opportunity to consult with an adult of my choosing.

Signature of Father

SECTION A – ACKNOWLEDGEMENT OF PATERNITY

We, ____________________________________________ and ____________________________________________ have read and understand the

Father’s full legal name

Mother’s full legal name

consequences, alternatives, rights and responsibilities regarding this affidavit and being duly sworn upon oath depose and say:

I, ______________________________________ am the biological father of _________________________________________, the Child referred to in

Father’s full legal nameChild’s full name at birth – last name same as Mother

SECTION D of this affidavit who was born on __________________ in ________________________ at ________________________, ____________

(mm/dd/yyyy)CityCountyState

________________________________________________________________________________________________________________________.

Hospital or address of location of birth

I, ___________________________________________ whose maiden name is ___________________________________________, am the mother

Mother’s full legal nameMother’s full maiden name

of the child referred to in Section D of this affidavit and that ____________________________________________ is the biological father of that child.

Father’s full legal name

Therefore, I wish for the birth certificate to identify him as the father.

SECTION B – BIOLOGICAL FATHER’S FACTS OF BIRTH

Full Legal Name

 

 

Social Security Number (Pursuant to IC 16-37-2-2.1 (e)(2)(B))

 

Race (optional)

 

 

 

 

 

 

 

 

 

 

Date of Birth (mm/dd/yyyy)

 

Place of Birth (city, state,

and county)

 

 

 

 

 

 

 

 

 

 

 

Current Address (number and street, city, state, and ZIP

code)

 

 

 

 

 

Telephone number

 

 

 

 

 

 

 

 

(

)

Name of employer (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address of employer (number and street, city, state, and ZIP code) (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

Policy number (optional)

 

 

Medical insurance company (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION C – BIOLOGICAL MOTHER’S FACTS OF BIRTH

 

 

Full Legal Name

 

 

Social Security Number (Pursuant to IC 16-37-2-2.1 (e)(1)(B))

 

Race (optional)

 

 

 

 

 

 

 

 

 

Date of Birth (mm/dd/yyyy)

 

Place of Birth (city, state,

and county)

 

 

 

 

 

 

 

 

 

 

 

Current Address (number and street, city, state, and ZIP

code)

 

 

 

 

 

Telephone number

 

 

 

 

 

 

 

 

(

)

Name of employer (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address of employer (number and street, city, state, and ZIP code) (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

Policy number (optional)

 

 

Medical insurance company (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION D – CHILD’S NAME ON INDIANA CERTIFICATE OF BIRTH

 

 

It is our mutual desire that the name of our child on the Indiana Certificate of Birth shall be recorded as:

 

 

 

 

 

 

 

 

 

 

 

First

 

Middle

 

 

 

Last

 

 

 

 

 

 

 

 

 

 

Gender of Child

 

 

 

If known, last four (4) digits

child’s Social Security Number

 

 

Male

Female

Not Determined

 

 

 

X X X - X X -

 

 

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Local Health Department Number

File Date (mm/dd/yyyy)

State File Number

PA Number

SECTION E – NOTICE OF CONSEQUENCES, ALTERNATIVES, RIGHTS AND RESPONSIBILITIES

By signing this affidavit, I acknowledge that I have read and understand all of the following:

1.A man should NOT sign this form if he is not sure he is the biological father. I may seek a genetic test before signing this form. Signing a Paternity Affidavit is voluntary. I may not be able to reverse paternity and the legal responsibilities of support associated with it, once I sign a Paternity Affidavit.

2.I may sign a Paternity Affidavit at the local Health Department at any time before the child’s emancipation, as long as there is no father listed on the birth certificate.

3.A woman who knowingly or intentionally falsely names a man as the child’s biological father commits a Class A misdemeanor.

4.I received both written and verbal information about the legal effects of signing a Paternity Affidavit.

5.Since this form has legal consequences, I may want to consult an attorney before signing.

6.This affidavit is void if signed more than seventy-two (72) hours after the birth of the child or if signed after the mother has executed a consent to adoption and a petition to adopt has been filed.

7.If I am the presumed father and do not establish paternity now, but want the right to notice and a hearing regarding any adoption of the child, I must register with the Indiana Putative Father Registry through the Indiana State Department of Health.

8.If the mother is receiving or plans to receive public assistance (TANF or Medicaid), she may be required to cooperate in establishing paternity and obtaining a support order or face losing those benefits.

9.If I do not sign a Paternity Affidavit and am unsure about the paternity of the child, I may contact the Prosecuting Attorney’s office in my county for help establishing paternity. They will help arrange tests to establish paternity.

10.The custodial party may contact the Prosecuting Attorney’s Office in their county for the child support services below through the IV-D program.

●

Establishing paternity

●

Getting a court order for the payment of child support and medical support

●

Finding the absent parent

●

Enforcing child support and medical support orders

11.The completion of this legal document establishes paternity with no further court action required and gives the mother or the IV-D agency the right to obtain a child support order requiring the father to pay support.

12.The father will have parenting time as outlined by the Indiana Parenting Time Guidelines, unless a court rules differently. See www.in.gov/judiciary/rules/parenting.

13.A man has the right to withdraw/rescind his acknowledgment of paternity only within sixty (60) days of the date the Paternity Affidavit is completed. To do so he must file an action in a court with jurisdiction over paternity and may need to submit to and pay for genetic testing per IC 16-37-2-2.1(k- l). After sixty (60) days the father may not be able to reverse paternity, even if genetic tests prove he is not the biological father.

Signature of Mother

Signature of Father

Date (mm/dd/yyyy)

Date (mm/dd/yyyy)

SECTION F – ESTABLISHMENT OF JOINT LEGAL CUSTODY

If both mother and father agree, they may complete this section of the Paternity Affidavit to elect to share joint legal custody of the child named in Section D. Joint legal custody means both mother and father share authority and responsibility for the major decisions concerning the child’s upbringing, including the child’s education, health care and religious training. Also mother and father have equal access to the child’s school and medical records.

(Both signatures are required to share joint legal custody.)

1.

I wish to share joint legal custody of this child with the father listed in Section B of this affidavit.

Signature of Mother (go to 2, then 3): ____________________________________________________

I wish to share joint legal custody of this child with the mother listed in Section C of this affidavit. Signature of Father (go to 2, then 3): _____________________________________________________

2.If you have chosen to share joint legal custody, the mother still has primary physical custody of the child unless another determination is made in a

court proceeding under Indiana Code 31-14.

Initials of Mother: _________ Initials of Father: _________

3.If you agree to share joint legal custody, you MUST submit the results of a genetic test, performed by an accredited laboratory no later than sixty (60) days after the child’s birth, that indicate the father listed in Section B is the biological father of the child. Otherwise, your agreement to share joint legal custody will be void. However the establishment of paternity IS still VALID. Initials of Mother: _________ Initials of Father: _________

4. I do NOT wish to share joint legal custody of this child and I understand this affidavit may still be used to establish paternity if the other sections are properly completed. (Only one signature is required but both may sign.)

Signature of Mother (go to 5): ____________________________________________________

Signature of Father (go to 5): ____________________________________________________

5.If you have chosen NOT to share joint legal custody, the mother has SOLE legal custody unless another determination is made in a court proceeding under Indiana Code 31-14. However the establishment of paternity (SECTIONS A - E) IS still VALID.

Initials of Mother: _________ Initials of Father: _________

Subscribed and sworn to before me, the undersigned, a Notary Public, in and for said county, this ________ day of _______________, 2________.

Signature of Notary

Printed Name of Notary

My Commission Expires (mm,dd,yyyy)

County of Residence

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▼ PDF

Document Specifics

Fact Name Details
Purpose The Indiana Paternity Affidavit 44780 form is used to establish paternity for a child born to unmarried parents.
Governing Law This form is governed by Indiana Code Title 16, Article 37, which pertains to the establishment of paternity.
Filing Process Parents must complete and sign the affidavit, which can be filed with the local health department or at the time of the child's birth.
Legal Implications By signing the affidavit, both parents acknowledge their legal responsibilities and rights regarding the child.

Indiana Paternity Affidavit 44780: Usage Instruction

After obtaining the Indiana Paternity Affidavit 44780 form, individuals will need to complete it accurately to ensure that the necessary information is recorded. This form is typically used to establish paternity and may be required in various legal situations.

  1. Begin by downloading the Indiana Paternity Affidavit 44780 form from the official state website or obtain a physical copy from a local office.
  2. Carefully read the instructions provided with the form to understand the requirements.
  3. Fill in the full names of both parents in the designated sections, ensuring that spelling is correct.
  4. Provide the date of birth for each parent in the appropriate fields.
  5. Enter the address for both parents, including street, city, state, and zip code.
  6. Complete the section regarding the child’s information, including the child's full name and date of birth.
  7. Sign the form in the designated area. Both parents must sign in front of a notary public.
  8. Have the form notarized. This step is crucial for the affidavit to be legally binding.
  9. Make copies of the completed and notarized form for your records.
  10. Submit the original notarized affidavit to the appropriate court or agency as required.

Learn More on Indiana Paternity Affidavit 44780

What is the Indiana Paternity Affidavit 44780 form?

The Indiana Paternity Affidavit 44780 form is a legal document used to establish the paternity of a child born to unmarried parents. By signing this affidavit, both parents acknowledge that the man named in the document is the biological father of the child. This form is essential for ensuring that the child has legal rights and benefits associated with having a father, such as inheritance rights and access to health insurance.

Who can complete the Indiana Paternity Affidavit 44780 form?

The affidavit can be completed by both the mother and the father of the child. It is important that both parents voluntarily agree to sign the form. If either parent is unsure about the paternity or has concerns, it is advisable to seek legal counsel before signing the affidavit.

Where can I obtain the Indiana Paternity Affidavit 44780 form?

The Indiana Paternity Affidavit 44780 form can be obtained from several sources:

  • Local health departments
  • Hospital maternity wards
  • The Indiana State Department of Health website
  • Family law offices

It is important to ensure that you are using the most current version of the form, as updates may occur.

What information is required on the Indiana Paternity Affidavit 44780 form?

The form requires several key pieces of information, including:

  1. The full names and addresses of both parents.
  2. The child's name and date of birth.
  3. Signatures of both parents, along with the date of signing.
  4. Information about any previous paternity tests, if applicable.

Completing the form accurately is crucial, as any errors could delay the establishment of paternity.

What happens after the Indiana Paternity Affidavit 44780 form is signed?

Once the affidavit is signed by both parents, it must be submitted to the appropriate state agency, typically the Indiana State Department of Health. After processing, the child's birth certificate can be amended to reflect the father's name, if necessary. This legal recognition is important for the child's rights and benefits.

Can the Indiana Paternity Affidavit 44780 form be revoked or changed?

Yes, the Indiana Paternity Affidavit can be challenged or revoked under certain circumstances. If new evidence arises that questions the paternity, or if there is a mutual agreement between the parents, a court may be involved to address the issue. It is advisable to consult with a legal professional if you find yourself in a situation where revocation is necessary.

Common mistakes

Filling out the Indiana Paternity Affidavit 44780 form can be a straightforward process, but many people make common mistakes that can lead to complications. One frequent error is failing to provide accurate personal information. This includes names, addresses, and dates of birth. Even a small typo can create issues later on.

Another mistake is not signing the affidavit in the presence of a notary public. The signature must be notarized to ensure that it is legally valid. Skipping this step can render the entire affidavit ineffective, meaning that the paternity establishment may not be recognized by the court.

Many individuals also overlook the importance of including the correct information about the child. This includes the child’s full name and date of birth. If this information is incorrect or missing, it can delay the process of establishing paternity.

Some people fail to understand the implications of the affidavit. They may not realize that signing the form can create legal rights and responsibilities. This includes child support obligations and custody rights. It’s crucial to fully understand these implications before signing.

Another common mistake is not providing the required identification. The form typically asks for a valid driver’s license number or another form of ID. Failing to include this information can lead to delays in processing the affidavit.

Individuals sometimes forget to check for consistency in the information provided. For instance, if the father’s name is spelled differently in various sections of the form, it can cause confusion. Consistency is key to ensuring the affidavit is accepted without issues.

People may also neglect to read the instructions carefully. Each section of the form has specific requirements. Not adhering to these can result in incomplete submissions and additional paperwork down the line.

Additionally, some individuals do not keep a copy of the completed affidavit for their records. This can be problematic if there are questions or disputes in the future. Keeping a copy ensures that you have proof of what was submitted.

Finally, failing to submit the affidavit in a timely manner can lead to complications. There are deadlines associated with establishing paternity, and missing these can affect custody and support arrangements. Timeliness is crucial in ensuring that all rights and responsibilities are recognized.

Documents used along the form

The Indiana Paternity Affidavit 44780 form is an important document for establishing paternity in the state of Indiana. When dealing with paternity issues, several other forms and documents may also be needed to support your case. Here is a list of commonly used forms that can accompany the Indiana Paternity Affidavit.

  • Child Support Worksheet: This form calculates the amount of child support that one parent may be required to pay. It considers income, expenses, and the needs of the child.
  • Custody Agreement: A document that outlines the custody arrangements for the child, detailing where the child will live and how decisions will be made.
  • Visitation Schedule: This form specifies the times and conditions under which the non-custodial parent can visit the child, ensuring both parents have clear expectations.
  • Declaration of Paternity: A sworn statement that confirms the identity of the father, which can be used in legal proceedings to establish paternity.
  • Medical History Form: A document that collects medical history from both parents, which can be important for the child’s health and future medical care.
  • Parenting Plan: A comprehensive document that outlines how parents will raise their child together, including education, healthcare, and other important decisions.
  • Income Verification Form: This form is used to verify the income of both parents, which can impact child support calculations.
  • Affidavit of Support: A sworn statement that may be required to prove financial support for the child, often used in conjunction with child support agreements.
  • Proof of Residency: Documentation that shows where each parent lives, which can be important for custody and visitation considerations.

Understanding these forms and documents can help make the process of establishing paternity smoother. It is essential to have the right paperwork in place to protect the rights and responsibilities of both parents and ensure the best interests of the child are met.

Similar forms

The Indiana Paternity Affidavit 44780 form shares similarities with the Acknowledgment of Paternity form. Both documents serve to establish paternity for a child born to unmarried parents. They require signatures from both parents, affirming that they agree on the identity of the child's father. Once completed, these forms can be filed with the appropriate state agency, helping to ensure that the child's legal rights are recognized and that they can access benefits associated with having a legally acknowledged father.

Another document that resembles the Indiana Paternity Affidavit is the Voluntary Acknowledgment of Paternity (VAP). Like the Indiana Paternity Affidavit, the VAP is typically completed at the hospital when a child is born. It allows both parents to voluntarily acknowledge the father’s paternity without the need for a court order. This document is crucial for establishing a legal relationship between the father and child, which can affect custody, child support, and inheritance rights.

The Child Support Worksheet is also similar in purpose, as it is often used in conjunction with paternity establishment. While it does not directly establish paternity, it helps determine the financial responsibilities of the father once paternity has been acknowledged. This worksheet outlines the income of both parents and calculates the appropriate child support amount, ensuring that the child's needs are met after paternity is established.

The Declaration of Paternity is another document that serves a similar function. This declaration can be used in cases where paternity needs to be established for legal reasons, such as custody disputes or inheritance claims. It requires the same level of agreement from both parents regarding the identity of the father, and once signed, it carries legal weight in family court matters.

Additionally, the Parentage Action form is relevant in this context. This legal document is filed with the court to formally establish paternity when parents cannot agree or when one parent contests paternity. While it is more formal than the Indiana Paternity Affidavit, it ultimately serves the same purpose: to legally determine who the father of a child is, which can impact custody, visitation, and support arrangements.

Lastly, the Affidavit of Support is similar in that it relates to the responsibilities of a parent. Although it primarily focuses on financial support rather than establishing paternity, it highlights the obligations that come with being a recognized parent. This document ensures that the child’s needs are met, reinforcing the importance of both emotional and financial support in the parent-child relationship.

Dos and Don'ts

Filling out the Indiana Paternity Affidavit 44780 form is an important step in establishing legal paternity. To ensure the process goes smoothly, consider the following dos and don'ts:

  • Do read the instructions carefully before starting.
  • Do provide accurate information about both parents.
  • Do sign the form in front of a notary public.
  • Do keep a copy of the completed form for your records.
  • Do file the form with the appropriate court or agency promptly.
  • Don't leave any required fields blank.
  • Don't use nicknames or abbreviations for names.
  • Don't forget to date your signature.
  • Don't alter or erase any information on the form.
  • Don't submit the form without ensuring both parents have signed it.

By following these guidelines, you can help ensure that the affidavit is completed correctly and efficiently. This can save time and avoid potential complications down the line.

Misconceptions

The Indiana Paternity Affidavit 44780 form is an important document for establishing paternity. However, several misconceptions surround its use and implications. Here are five common misunderstandings:

  1. It is only for unmarried parents.

    While the form is often associated with unmarried parents, it can also be used in cases where parents are married but wish to establish paternity for a child born outside of the marriage.

  2. Signing the affidavit automatically grants custody.

    Signing the Indiana Paternity Affidavit does not automatically confer custody rights. Custody arrangements must be determined separately through legal processes.

  3. The affidavit is permanent and cannot be changed.

    The affidavit can be contested or changed in court if there is evidence to support a claim that paternity should be established differently.

  4. Only the father needs to sign the affidavit.

    Both parents must sign the affidavit to establish paternity legally. This ensures that both parties acknowledge and accept their roles and responsibilities.

  5. It is only necessary for legal reasons.

    While the affidavit serves legal purposes, it also helps in securing child support and benefits, such as health insurance and inheritance rights, for the child.

Key takeaways

The Indiana Paternity Affidavit 44780 form is an important document for establishing paternity in the state of Indiana. Here are some key takeaways regarding its use and completion:

  • The form is used to legally establish the paternity of a child when the parents are not married.
  • Both parents must sign the affidavit in the presence of a notary public.
  • Filling out the form accurately is crucial, as incorrect information can lead to legal complications.
  • The affidavit can be submitted at the time of the child's birth or at a later date.
  • Once filed, the affidavit has the same legal standing as a court order establishing paternity.
  • Parents can revoke the affidavit within 60 days if they change their minds.
  • After the 60-day period, the affidavit can only be challenged in court.
  • It is advisable to seek legal advice if there are disputes regarding paternity.
  • The completed form should be submitted to the appropriate local health department or vital records office.