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Affidavit of Parentage

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STATE OF NORTH CAROLINA 
 
____________________COUNTY 
 
 	
AFFIDAVIT OF PARENTAGE 
 	
If this is a re-adoption by a second adoptive parent, check here	 □	 and provide original adoptive 
parent information below in lieu of biological parent information. 	
 	
  I, the undersigned, _____________________________________________________________, being duly sworn,  
[Mother]   [Father]   [Guardian]  [Other Knowledgeable Individual]   
declare the following persons to be the parents or possible parents of ____________________________ ___________, 
                  (Original Name of Child) 
 
a minor ____________child, who was born on the  ___________ day of ___________________________ , _________, 
       (Sex) 
 
 [or expected to be born approximately __________________________ ] in __________________________________ 
                    (City or Town) 
____________________________________________________.  
  (County)    (State) 
 
Birth Parent or  
Prior Adoptive Parent 1:     ____________________________________      _________________________________ 
                    (Name)      (Marital status at time of child's birth) 
 
     ________________________________________________________________________\
_______________  
(Last known address) 
 
Birth Parent or  
Prior Adoptive Parent 2:     ____________________________________      _________________________________  
                   (Name)      (Marital status at time of child's birth) 
 
     ________________________________________________________________________\
_______________  
(Last known address) 
(If more than one possible) 
Biological 
Father:      _____________________________________________     _______________________________________ 
              (Name)             (Marital status at time of child's birth) 
 
     ________________________________________________________________________\
_______________  
(Last known address) 
 
Legal 
Father:     _____________________________________________     _______________________________________ 
              (Name)             (Marital status at time of child's birth) 
 
     _______________________________________________________________________________________  
(Last known address) 
 
                                         
 
 
 
DSS-1809 (Rev.  11/2014) 
Child Welfare Services  Page 1 of 2

STATE OF ______________________________ 
 
COUNTY OF  ____________________________ 
 
 
 
Source of  my knowledge  (if not signed by placing parent or guardian):   _____________________________________  
________________________________________________________________________\
_______________________
________________________________________________________________________\
_ ______________________ 
 
 
FURTHER ,  it  is  the  intent  of  the  undersigned  parent  or  guardian  to  place  the  above-named  child  for  adoption  in 
accordance with Chapter 48 of the General Statutes of North Carolina. 
 
 
            ____________________________________________________ 
                  Signature of     (Mother)   (Father)   (Guardian)    
                            (Other Knowledgeable Individual) 
 
 
 
 
I,  _______________________________________________________________________________, do hereby certify   
          (Name of official) 
 
that  ____________________________________________________________ personally appeared before me this day   
  (Name of parent or guardian or other knowledgeable individual) 
 
and acknowledged the due execution of the foregoing instrument. 
 
I  certify  that  I,  the  undersigned,  am  a  Notary  Public  or  one  otherwise  empowered  to  acknowledge  signatures  under 
Chapter 47 of the General Statutes of North Carolina. 
 
Witness my hand and seal this the  ______________ day of __________________________________,  ____________. 
 
 
 
 
              Signature  _____________________________________ 
(S E A L) 
 
              Title   _____________________________________  
 
 
My commission expires _______________________________ 
 
 
NOTE:  
One Form DSS-1809 is obtained at the time the Consent to Adoption (DSS-1802) or Relinquishment to Adoption (DSS-
1804) is signed and filed in the adoption proceeding.   The Clerk then forwards these documents to the Division of Social 
Services, State Department of Health and Human Services, after the entry of the final decree. 
 
G.S. 48-3-206 provides that in the event the placing parent or guardian is unavailable, this information may be provided 
by  another  knowledgeable  individual  who  should  then  sign  this  form  and  indicate  the  source  of  his  knowledge.    This 
affidavit  is  not  necessary  when  an  agency  acquires  legal  and  physical  custody  of  a  minor  for  adoption  by  court  order 
terminating the parental rights of both parents or guardian. 
 
 
DSS-1809 (Rev.  11/2014) 
Child Welfare Services  Page 2 of 2
Relevant article from our knowledge database

For that, parentage has to be established legally. Establishing parentage is vital for a kid. Parentage and relevant support issues are complicated.
Read more

A mother could possibly be hesitant to mention the father for a lot of reasons. If she agrees, the baby can have the father's last name. Whether or not you're the mother of the kid or the potential father, you might want to learn the outcome of the DNA testing privately, and make a decision as to what to do with the outcomes.

On account of the significance of the outcome, it might be sensible to get hold of a lawyer. In addition, employing an attorney usually means you could minimize contact by means of your spouse, as they will generally must communicate with you only through your lawyer. You should talk with a lawyer concerning legal problems, but you don't need a lawyer to submit a paternity case.

There are a number of special reasons to set up paternity. It is the legal identification of a child's natural father when the parents are not married. When it has been established it means that someone has been named the legal father of a child. It is possible to establish paternity working with an Affidavit up until your kid's 18th birthday. The second method to set up paternity is via the judicial procedure. This way is called involuntary because someone disputes paternity, which explains why it will become a court issue.

Next: Affidavit of Financial Disclosure Parents (Private-Placement) Previous: Affidavit of Adopted Person
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