Florida Rules of Juvenile Procedure
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8.969 Sworn Statement Regarding Identity or Location of Father
SWORN STATEMENT REGARDING
IDENTITY OR LOCATION OF FATHER
1. My name is: ............................................................
My address is: ........................................................
2. I am related to .....(child’s name)..... because I am
his/her ..........................
3. I understand that I am answering these questions
under oath and from my own personal knowledge and
I swear to tell the truth. I understand
that this sworn
statement will be filed with the court.
4. The mother of the child WAS married to
.....(name)..... at the probable time of conception of the
child.
OR
The mother of the child WAS NOT married at the
probable time of conception of the child.
OR
I do not know whether or not the mother was married
at the probable time of conception of the child.
5. The mother of this child WAS married to
.....(name)..... at the time of this child’s birth.
OR
The mother of this child WAS NOT married at the
time of this child’s birth.
OR
I do not know whether the mother of this child was
married at the time of this child’s birth.
6. The mother of this child WAS living with/cohabiting
with .....(name)..... at the time of the probable conception
of this child.
OR
The mother of this child WAS NOT living with/cohabiting
with any man at the probable time of conception
of this child.
OR
I do not know whether the mother of this child was
living with/cohabiting with any man at the probable
time of conception of this child.
7. The mother of this child HAS received payments
or promises of child support with respect to this child
or because of her pregnancy from .....(name)......
OR
The mother of this child HAS NOT received payments
or promises of child support with respect to this
child or because of her pregnancy from anyone.
OR
I do not know whether the mother has received any
payments.
8. The mother named .................... as the father on the
child’s birth certificate.
OR
The mother DID NOT name a father on the child’s
birth certificate.
OR
I do not know whether the mother named a father on
the child’s birth certificate.
9. The mother named .................... as the father of
this child in connection with applying for public
assistance.
OR
The mother HAS NOT named anyone as the father
of this child in connection with applying for public
assistance.
OR
I do not know whether the mother has named anyone
as the father of this child in connection with applying
for public assistance benefits.
10. .....(Name)..... has been named in a paternity case
or acknowledged paternity in a jurisdiction where the
mother lived at the time of or since the conception of
this child or where this child resides or has resided.
OR
No man has been named in a paternity case or acknowledged
paternity of this child in a jurisdiction
where the mother lived at the time of or since the conception
of this child or where this child resides or has
resided.
OR
I do not know if any man has been named in a paternity
suit regarding this child.
11. List the name, date of birth, social security number,
and last-known address of any man listed in this
sworn statement:
Name: .........................................................................
Date of birth: .....................
Social Security No.: .....................
Last-known address: ..................................................
12. Do you know any other information about the
identity or location of any man listed in this sworn
statement? ..... Yes ..... No. If so, please give that information:
..........................................................................
I UNDERSTAND THAT THIS DOCUMENT
WILL BE FILED WITH THE COURT. UNDER
PENALTY OF PERJURY, I DECLARE THAT I
HAVE READ IT AND THAT THE FACTS STATED
ARE TRUE.
Date: ..........
__________________
Signature
Witnessed by .....(name)....., who is an authorized
agent of the Department of Children and Family Services
and who attests that the person who signed this
statement provided proof of identify as indicated:
..... Driver’s license, number: ....................................
..... Passport, number and country: ...........................
..... Resident Alien (Green Card), number: ...............
..... Armed Forces Identification, number: ................
..... Other: ..................................................................
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