WebLearn
Homepage ↝ Blank Indiana Paternity Affidavit 44780 Form
Outline

The Indiana Paternity Affidavit 44780 form plays a crucial role in establishing legal parentage in the state of Indiana. This form is primarily used by parents who wish to affirm paternity when a child is born to unmarried individuals. Completing this affidavit can simplify various legal processes, such as child support, custody, and visitation rights. It serves as a voluntary acknowledgment of paternity, allowing the father to take responsibility for the child and ensuring that the child has access to benefits that come from having a legally recognized father. The form requires specific information, including the names of both parents, the child's details, and the signatures of both parties, which must be witnessed or notarized. Understanding the implications of this affidavit is essential for unmarried parents, as it not only affects their rights and responsibilities but also the legal status of their child. By filing this form, parents can help secure their child's future and establish a formal relationship that is recognized by the state.

Sample - 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 -

 

 

Page 1 of 2

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

Page 2 of 2

Click for PDF

Form Information

Fact Name Details
Purpose The Indiana Paternity Affidavit 44780 form establishes the legal father of a child when the parents are not married.
Governing Law Indiana Code § 16-37-2-2 governs the use of paternity affidavits in the state.
Eligibility Both parents must voluntarily sign the affidavit to establish paternity.
Filing Location The completed form should be filed with the local health department or the hospital where the child was born.
Legal Rights Signing the affidavit grants the father legal rights and responsibilities, including custody and child support obligations.
Timeframe The affidavit can be signed at the time of the child's birth or within a specified period thereafter.
Revocation There are procedures in place for revoking the affidavit, typically within a certain timeframe after signing.
Notarization While notarization is not required, it is recommended to ensure the authenticity of the signatures.
Impact on Benefits Establishing paternity can impact eligibility for benefits such as health insurance and social security.

Detailed Guide for Filling Out Indiana Paternity Affidavit 44780

Filling out the Indiana Paternity Affidavit 44780 form is an important step in establishing paternity. Once completed, you will submit this form to the appropriate authorities to formalize the recognition of a child's father. Follow these steps to ensure the form is filled out correctly.

  1. Begin by downloading the Indiana Paternity Affidavit 44780 form from the Indiana government website or obtain a physical copy from a local office.
  2. Read the instructions carefully to understand the information required.
  3. Fill in the names of both parents in the designated sections, ensuring that you provide accurate legal names.
  4. Provide the child's name and date of birth in the appropriate fields.
  5. Complete the section regarding the parents' addresses, including street, city, state, and ZIP code.
  6. Indicate the parents' marital status at the time of the child’s birth.
  7. Both parents must sign the form in the designated areas. Ensure that signatures are dated.
  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 form to the local vital records office or the appropriate agency as instructed.

Obtain Answers on Indiana Paternity Affidavit 44780

  1. 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 in the state of Indiana. This form is typically completed by both parents and serves as a formal acknowledgment of the biological father’s relationship to the child. By signing this affidavit, the father accepts legal responsibility for the child, which can include financial support and other parental rights.

  2. Who should fill out the Paternity Affidavit?

    Both the mother and the father of the child should fill out the Indiana Paternity Affidavit 44780 form. It is important that both parties are in agreement regarding the paternity of the child. This form can be completed at the hospital when the child is born or later at a local health department or child support office.

  3. What information is required on the form?

    The affidavit requires several pieces of information, including:

    • The full names and addresses of both parents.
    • The name and date of birth of the child.
    • Signatures of both parents, affirming their agreement to the paternity acknowledgment.

    Additional information may also be requested, such as Social Security numbers, but this can vary by location.

  4. What happens after the form is submitted?

    Once the Indiana Paternity Affidavit 44780 form is signed and submitted, it is filed with the Indiana State Department of Health. This filing creates a legal record of paternity, which can be important for various reasons, including child support, custody, and inheritance rights. It is advisable to keep a copy of the signed affidavit for personal records.

  5. Can the affidavit be revoked or changed?

    Yes, the Indiana Paternity Affidavit can be challenged or revoked under certain circumstances. If either party believes that the affidavit was signed under duress or if new evidence arises that questions paternity, a court may be involved to resolve the matter. It is important to consult with a legal professional if you are considering revocation or modification of the affidavit.

Common mistakes

Filling out the Indiana Paternity Affidavit 44780 form is a critical step for establishing paternity. However, many individuals make common mistakes that can lead to complications down the line. One frequent error is not providing accurate personal information. This includes names, addresses, and dates of birth. Any discrepancies can cause delays in processing or even result in the affidavit being rejected.

Another mistake often seen is failing to have the form notarized. The Indiana Paternity Affidavit requires notarization to be legally valid. Without this step, the affidavit may not hold up in court or be recognized by state agencies. It's essential to ensure that both parents sign the document in the presence of a notary public.

Some individuals overlook the importance of providing complete information about the child. This includes the child’s full name and date of birth. Omitting this information can create confusion and may require additional steps to rectify the situation. It's crucial to double-check that all details about the child are accurate and clearly stated.

Additionally, people sometimes neglect to read the instructions carefully. Each section of the form has specific requirements. Misunderstanding these can lead to incomplete submissions. Taking the time to thoroughly review the instructions can help avoid this pitfall.

Another common error is not understanding the implications of signing the affidavit. By signing, both parents are acknowledging legal responsibilities and rights regarding the child. Some individuals may not fully grasp the long-term consequences, which can affect custody and child support arrangements. It’s advisable to seek guidance if there are any uncertainties.

Furthermore, individuals often fail to keep copies of the completed affidavit. After submission, having a personal record is vital. This can be useful for future reference or in case any issues arise later. Keeping a copy ensures that both parents have access to the same information.

Lastly, some people mistakenly believe that the affidavit alone is sufficient for establishing paternity. While it is an important step, further legal actions may be necessary to secure parental rights or responsibilities. Consulting with a legal professional can provide clarity on the next steps after submitting the affidavit.

Documents used along the form

When navigating the process of establishing paternity in Indiana, several important documents often accompany the Indiana Paternity Affidavit 44780. Each of these forms plays a vital role in ensuring that the rights and responsibilities of all parties involved are clearly defined. Here’s a brief overview of some commonly used documents.

  • Birth Certificate: This document officially records the birth of a child and may need to be updated to reflect the father's name once paternity is established.
  • Child Support Worksheet: This form helps calculate the amount of financial support the non-custodial parent is required to provide, based on income and other factors.
  • Parenting Time Guidelines: This document outlines the rights and responsibilities of each parent regarding time spent with the child, helping to create a fair schedule.
  • Custody Agreement: If parents are not living together, this form details the custody arrangements for the child, including physical and legal custody terms.
  • Medical Authorization Form: This allows one parent to make medical decisions for the child, ensuring that necessary healthcare can be accessed without delay.
  • Financial Affidavit: This document provides a detailed account of each parent's financial situation, which can be essential for determining support obligations.

Understanding these documents and their purposes can simplify the process of establishing paternity and ensure that both parents are on the same page. Being well-prepared can lead to smoother interactions and better outcomes for everyone involved.

Similar forms

  • Voluntary Acknowledgment of Paternity (VAP): This document allows parents to voluntarily acknowledge the paternity of a child. Like the Indiana Paternity Affidavit, it serves to establish legal parentage and can be signed at the hospital or later. Both forms are used to ensure that the father's name is on the child's birth certificate.
  • Paternity Petition: This is a legal document filed with the court to establish paternity. Unlike the Indiana Paternity Affidavit, which is an administrative process, a paternity petition involves court proceedings. Both documents aim to determine legal fatherhood but differ in their processes.
  • Child Support Order: This document outlines the financial obligations of a non-custodial parent. While the Indiana Paternity Affidavit establishes paternity, a child support order typically follows to ensure that the child’s needs are met. Both documents are essential in matters of child welfare.
  • Custody Agreement: This agreement outlines the terms of child custody between parents. Similar to the Indiana Paternity Affidavit, it addresses the rights and responsibilities of parents. Establishing paternity is often a prerequisite for custody arrangements.
  • Parenting Plan: This document details how parents will raise their child after separation or divorce. Like the Indiana Paternity Affidavit, it is crucial for ensuring the child's best interests are met. Both documents emphasize the importance of parental involvement.
  • Birth Certificate: A birth certificate records a child's birth and parentage. The Indiana Paternity Affidavit can be used to add a father's name to the birth certificate if paternity is established. Both documents are vital for legal identification and rights of the child.

Dos and Don'ts

Filling out the Indiana Paternity Affidavit 44780 form is an important step in establishing paternity. To ensure that the process goes smoothly, here are some key things to do and avoid.

  • Do read the instructions carefully before starting the form.
  • Do provide accurate and complete information about both parents.
  • Do sign the form in the presence of a notary public.
  • Do keep a copy of the completed affidavit for your records.
  • Don't leave any sections blank; if a section does not apply, write "N/A."
  • Don't use correction fluid or tape on the form; if you make a mistake, cross it out neatly and initial it.

By following these guidelines, you can help ensure that the Indiana Paternity Affidavit is filled out correctly and efficiently.

Misconceptions

The Indiana Paternity Affidavit 44780 form is an important document used to establish paternity in the state of Indiana. However, several misconceptions surround its use and implications. Below is a list of ten common misunderstandings about this form, along with explanations to clarify each point.

  • Only married couples can use the form. Many believe that the affidavit is exclusive to married parents. In reality, it can be used by both married and unmarried parents to establish paternity.
  • The form automatically grants custody rights. Some people think that signing the affidavit gives one parent automatic custody of the child. However, custody arrangements must be determined separately through the court.
  • Signing the affidavit means you cannot contest paternity later. There is a misconception that once the affidavit is signed, it cannot be challenged. In fact, there are legal avenues available to contest paternity under certain circumstances.
  • It must be filed with a lawyer. Many assume that legal representation is necessary to file the affidavit. However, parents can complete and submit the form on their own without needing a lawyer.
  • The form is only for biological parents. Some people believe that only biological parents can sign the affidavit. In truth, anyone who is legally recognized as a parent can use the form.
  • It is only relevant for child support cases. While the affidavit can be used in child support matters, it is also crucial for establishing legal rights regarding custody and visitation.
  • Signing the form is a permanent decision. There is a common belief that signing the affidavit permanently establishes paternity. However, it can be rescinded or modified under certain conditions.
  • All states use the same form. Some individuals think that the Indiana Paternity Affidavit is standard across all states. Each state has its own requirements and forms for establishing paternity.
  • The affidavit is not legally binding. There is a misconception that the affidavit has no legal weight. In fact, it is a legally binding document once signed and filed, provided it meets state requirements.
  • It can only be signed at the hospital. Many believe that the affidavit must be completed immediately after the child's birth at the hospital. While it can be done there, it can also be signed later at other locations, such as local health departments or county clerks' offices.

Understanding these misconceptions can help individuals navigate the paternity process more effectively. It is essential to have accurate information to make informed decisions regarding parental rights and responsibilities.

Key takeaways

Here are some key takeaways about filling out and using the Indiana Paternity Affidavit 44780 form:

  1. The form is used to establish paternity for a child born to unmarried parents.
  2. Both parents must sign the affidavit in the presence of a notary public.
  3. The form can be filled out at the hospital after the child's birth or later at a local health department.
  4. It is important to provide accurate information about both parents and the child.
  5. Filing the affidavit creates a legal presumption of paternity.
  6. Once signed, the affidavit is filed with the Indiana State Department of Health.
  7. Both parents should keep a copy of the signed affidavit for their records.
  8. Filing the affidavit can help with child support and custody issues in the future.
  9. If either parent is unsure about signing, they should seek legal advice.
  10. The affidavit can be revoked or challenged in court if necessary.

Completing the Indiana Paternity Affidavit 44780 form is an important step in establishing a child's legal relationship with both parents.