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The Indiana Paternity Affidavit 44780 form plays a crucial role in establishing legal paternity in the state of Indiana. This form is typically used when parents are unmarried and wish to formally recognize the father of a child. By completing this affidavit, both parents can affirm their relationship to the child, which is essential for various legal rights and responsibilities. The form requires personal information from both parents, including names, addresses, and dates of birth. It also includes spaces for signatures, indicating that both parties agree to the terms outlined in the affidavit. Once completed and signed, the affidavit must be filed with the appropriate state agency to ensure that the father’s name is added to the child’s birth certificate. This process not only helps in securing the father's legal rights but also benefits the child by providing access to child support, inheritance rights, and health insurance coverage. Understanding how to properly fill out and submit the Indiana Paternity Affidavit 44780 is vital for any unmarried parents looking to establish their child's paternity effectively.

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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 File

Form Specifications

Fact Name Details
Purpose The Indiana Paternity Affidavit 44780 form establishes legal fatherhood for a child born to unmarried parents.
Governing Law The form is governed by Indiana Code § 16-37-2-2.
Eligibility Both parents must be present to sign the affidavit for it to be valid.
Filing Location The completed form should be filed with the local health department or vital records office.
Impact on Child Support Establishing paternity can affect child support obligations and custody arrangements.
Effect on Rights Filing the affidavit grants the father legal rights and responsibilities regarding the child.
Deadline The affidavit should be completed at the time of the child's birth or shortly thereafter.
Signature Requirements The affidavit must be signed in the presence of a notary public or a witness.

Indiana Paternity Affidavit 44780: Usage Guidelines

Completing the Indiana Paternity Affidavit 44780 form is an important step in establishing legal paternity. Once the form is filled out correctly, it can be submitted to the appropriate authorities to ensure that the rights and responsibilities of all parties involved are recognized.

  1. Obtain the Indiana Paternity Affidavit 44780 form. You can find it online or request a physical copy from your local health department.
  2. Read the instructions carefully before you start filling out the form. This will help you understand what information is required.
  3. Begin with the top section of the form, where you will need to provide the names of both parents. Ensure that the names are spelled correctly.
  4. Fill in the date of birth for both parents. This information is necessary for identification purposes.
  5. Provide the name of the child. If the child has not yet been born, you can indicate "unborn" and include the expected due date.
  6. Complete the section regarding the address of both parents. This helps in establishing residency.
  7. Sign the affidavit in the designated area. Both parents must sign, acknowledging their agreement to the information provided.
  8. Have the affidavit notarized. A notary public will verify the identities of the signers and witness the signatures.
  9. Submit the completed and notarized form to the appropriate local agency, such as the health department or court, as instructed.

Your Questions, Answered

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. It is typically completed by both parents when the child is born, especially when the parents are not married. This form serves to legally recognize the father’s relationship to the child, which can have implications for custody, child support, and inheritance rights. By signing the affidavit, both parents affirm their understanding of the responsibilities that come with parenthood.

Who should complete the Indiana Paternity Affidavit 44780 form?

Both biological parents should complete the Indiana Paternity Affidavit 44780 form. This includes the mother and the father of the child. It is important for both parties to agree on the information provided in the affidavit. If the parents are unmarried at the time of the child’s birth, signing this form is essential for the father to be recognized as the legal parent. This form can be completed at the hospital when the child is born or later at a local health department or county office.

What information is required on the form?

The Indiana Paternity Affidavit 44780 form requires specific information from both parents. This includes their full names, addresses, and dates of birth. Additionally, the form asks for the child’s name and date of birth. Both parents must also provide their signatures, affirming the accuracy of the information. It may also include questions about any previous paternity determinations or legal actions related to the child. Accuracy is crucial, as any discrepancies could lead to complications in the future.

What happens after the form is submitted?

After the Indiana Paternity Affidavit 44780 form is completed and submitted, it is filed with the appropriate state agency. This filing officially establishes the father’s legal rights and responsibilities regarding the child. Once the affidavit is processed, it may be used to update the child’s birth certificate to include the father's name. This step is important for ensuring that the child has access to benefits such as health insurance and inheritance rights. Both parents should keep a copy of the signed affidavit for their records.

Common mistakes

  1. Not providing complete information. Every section of the form must be filled out accurately. Missing details can delay the process.

  2. Failing to sign the affidavit. A signature is essential to validate the document. Without it, the affidavit is not legally binding.

  3. Using incorrect names. Ensure that the names of both parents and the child are spelled correctly. Errors can cause confusion and complications.

  4. Not including the date of birth. This information is crucial for establishing paternity. Omitting it can lead to processing issues.

  5. Neglecting to have witnesses. The affidavit typically requires signatures from witnesses. Failing to include them can invalidate the form.

  6. Submitting the form without reviewing it. Always double-check for accuracy. Mistakes can be costly and time-consuming to fix.

  7. Ignoring local filing requirements. Each county may have specific rules for submission. Be sure to follow them to avoid delays.

  8. Not providing identification. Some jurisdictions require a form of ID to accompany the affidavit. Check the requirements to ensure compliance.

  9. Overlooking the need for notarization. In some cases, notarization is necessary for the affidavit to be accepted. Confirm if this step is needed.

  10. Assuming the form is the only requirement. Additional documentation may be needed for the paternity process. Research all necessary paperwork to ensure completeness.

Documents used along the form

The Indiana Paternity Affidavit 44780 form is an important document for establishing paternity in the state of Indiana. When filing this affidavit, several other forms and documents may be necessary to support the process. Below is a list of commonly used documents that often accompany the Indiana Paternity Affidavit.

  • Birth Certificate: This document provides official proof of the child's birth and includes details such as the child's name, date of birth, and parents' names.
  • Child Support Worksheet: This form outlines the financial responsibilities of the non-custodial parent regarding child support, helping to determine the appropriate amount.
  • Custody Agreement: If parents are not living together, this document outlines the arrangements for the child's living situation and visitation rights.
  • Health Insurance Information: This includes details about the child's health insurance coverage, which is essential for ensuring access to medical care.
  • Parenting Plan: A comprehensive document that details how parents will raise their child together, covering aspects like education, discipline, and communication.
  • Proof of Residency: This may include utility bills or lease agreements to establish where the child resides, which can be important for custody considerations.
  • Affidavit of Support: This form may be used to declare the financial support provided by one parent to the other, especially in cases where child support is contested.
  • DNA Test Results: If paternity is disputed, DNA test results can serve as crucial evidence to confirm or deny biological parentage.

Understanding these additional documents can help streamline the process of establishing paternity and ensure that all necessary information is provided. Each form serves a unique purpose and collectively supports the legal recognition of parental rights and responsibilities.

Similar forms

  • Paternity Acknowledgment Form: This document is used to establish paternity voluntarily. Like the Indiana Paternity Affidavit, it confirms the father’s acknowledgment of his child.
  • Child Support Worksheet: This form helps determine child support obligations. It relates to the Paternity Affidavit by outlining financial responsibilities once paternity is established.
  • Custody Agreement: This document outlines the arrangements for child custody. It is similar in that it often follows the establishment of paternity and addresses the child's living situation.
  • Visitation Agreement: This form details the visitation rights of the non-custodial parent. It connects to the Paternity Affidavit by ensuring that both parents have defined roles in the child’s life.
  • Child's Birth Certificate: Once paternity is established, the father's name can be added to the birth certificate. This document serves as legal proof of the child's identity and parentage.
  • Parenting Plan: This document outlines how parents will raise their child together. It is similar as it often follows paternity establishment and helps in planning for the child's upbringing.

Dos and Don'ts

When filling out the Indiana Paternity Affidavit 44780 form, it's important to be careful and thorough. Here are some helpful tips on what to do and what to avoid:

  • Do read the instructions carefully before starting the form.
  • Do provide accurate and complete information about both parents.
  • Do sign the affidavit in front of a notary public.
  • Do keep a copy of the completed form for your records.
  • Don't leave any required fields blank.
  • Don't use incorrect names or information that could cause confusion.
  • Don't forget to submit the form to the appropriate agency in a timely manner.

Misconceptions

The Indiana Paternity Affidavit 44780 form is an important document for establishing paternity in the state of Indiana. However, several misconceptions can lead to confusion. Here are five common misunderstandings about this form:

  • It is only for unmarried parents. Many believe that the affidavit can only be used by unmarried parents. While it is commonly used in these situations, it can also be beneficial for married couples who want to establish paternity for a child born outside of the marriage.
  • Signing the affidavit means you have to pay child support. Some people think that signing the affidavit automatically obligates them to pay child support. In reality, signing the form establishes paternity but does not create a child support obligation until a court order is issued.
  • The affidavit can be signed at any time. There is a misconception that the affidavit can be signed whenever it is convenient. However, it is best to complete the form at the hospital after the child’s birth, as this can streamline the process of establishing legal paternity.
  • Both parents must be present to sign the affidavit. While it is ideal for both parents to be present when signing the affidavit, it is not a strict requirement. One parent can sign it, and the other can sign it later, as long as both parents eventually complete the form.
  • The affidavit is a permanent legal document. Some individuals believe that once the affidavit is signed, it cannot be changed or contested. In fact, if there are valid reasons, either parent can challenge the paternity established by the affidavit through a court process.

Understanding these misconceptions can help parents navigate the process of establishing paternity more effectively. It’s always a good idea to consult with a legal professional if there are any uncertainties about the form or the implications of signing it.

Key takeaways

Understanding the Indiana Paternity Affidavit 44780 form is essential for establishing legal parentage. Here are some key takeaways to consider:

  1. Purpose of the Form: The Indiana Paternity Affidavit is used to legally establish the paternity of a child when the parents are not married.
  2. Who Can File: Both parents must sign the affidavit to acknowledge paternity. This includes the biological father and the mother.
  3. When to Use: The form is typically filled out at the hospital when the child is born or can be completed later at a local health department.
  4. Importance of Signing: Signing the affidavit grants the father legal rights and responsibilities, including custody and child support obligations.
  5. Notarization Requirement: The affidavit must be notarized to be considered valid. This ensures that both parties understand the implications of signing.
  6. Impact on Child’s Rights: Establishing paternity through this affidavit allows the child to access benefits such as inheritance, health insurance, and social security.
  7. Correct Information: It is crucial to provide accurate information on the form. Errors can lead to complications in establishing paternity.
  8. Legal Assistance: If there are any uncertainties about filling out the form, seeking legal advice can help clarify the process.
  9. Filing with the State: After signing, the affidavit should be filed with the Indiana State Department of Health to ensure it is officially recorded.
  10. Revocation: If circumstances change, there are legal processes available to challenge or revoke the paternity affidavit.

Taking the time to understand and properly complete the Indiana Paternity Affidavit 44780 form can have lasting benefits for both parents and the child involved. It is a significant step toward ensuring that the child's rights are protected and that both parents are recognized in the eyes of the law.