Outline
Understanding the Indiana Paternity Affidavit 44780 form is essential for parents navigating the complexities of establishing paternity in the state of Indiana. This important document serves as a legal declaration acknowledging the father of a child, which can significantly influence various aspects of parental rights and responsibilities. By completing this form, both parents can affirm their relationship to the child, thereby facilitating access to benefits such as child support, health insurance, and inheritance rights. The affidavit is typically signed voluntarily by both parents, often in the presence of a notary, and is crucial in situations where the parents are unmarried. Furthermore, the form simplifies the process of establishing paternity without the need for lengthy court proceedings, making it a practical tool for families. Understanding the implications of this affidavit can empower parents to make informed decisions that will positively impact their child's future.
Form Sample
PATERNITY AFFIDAVIT – HOSPITAL USE
State Form 44780 (R7 /
INDIANA STATE DEPARTMENT OF HEALTH
Local Health Department Number |
File Date (mm/dd/yyyy) |
State File Number |
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Statutory Authority IC
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
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Current Address (number and street, city, state, and ZIP |
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Address of employer (number and street, city, state, and ZIP code) (optional) |
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Policy number (optional) |
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SECTION C – BIOLOGICAL MOTHER’S FACTS OF BIRTH |
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Full Legal Name |
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Social Security Number (Pursuant to IC |
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Race (optional) |
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Date of Birth (mm/dd/yyyy) |
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Place of Birth (city, state, |
and county) |
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Current Address (number and street, city, state, and ZIP |
code) |
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Telephone number |
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Name of employer (optional) |
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Address of employer (number and street, city, state, and ZIP code) (optional) |
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Policy number (optional) |
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SECTION D – CHILD’S NAME ON INDIANA CERTIFICATE OF BIRTH |
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It is our mutual desire that the name of our child on the Indiana Certificate of Birth shall be recorded as: |
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Last |
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Gender of Child |
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If known, last four (4) digits |
child’s Social Security Number |
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Female |
Not Determined |
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X X X - X X - |
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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
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
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Establishing paternity |
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Getting a court order for the payment of child support and medical support |
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Finding the absent parent |
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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
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
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 |
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
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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Form Specifics
| Fact Name | Description |
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| Purpose | The Indiana Paternity Affidavit 44780 form is used to establish the legal father of a child born to unmarried parents. |
| Governing Law | This form is governed by Indiana Code Title 31, Article 14, which pertains to paternity and child support. |
| Eligibility | Both parents must be present to sign the affidavit, affirming their relationship to the child. |
| Filing Location | The completed affidavit should be filed with the local county health department or the hospital where the child was born. |
| Effect on Child Support | Establishing paternity through this affidavit can impact child support obligations and rights. |
| Signature Requirement | Both parents must sign the affidavit in the presence of a notary public to ensure its validity. |
| Access to Benefits | Once paternity is established, the child may gain access to benefits such as health insurance and inheritance rights. |
| Revocation | There are procedures in place for revoking the affidavit if either parent believes it was signed under duress or if new evidence arises. |
| Importance of Timeliness | It is recommended to complete and file the affidavit as soon as possible after the child's birth to avoid complications later. |
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