CJ-D 106 (7/15/15)
of
page
COMPLAINT TO ESTABLISH
PATERNITY
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
Division
,Plaintiff
v.
First Name
Last Name
M.I
First Name
Last Name
M.I
1.
a child born out of wedlock.
personal representative
parent
father
mother
Department of Revenue
an agency licensed under G. L. c. 28A
Department of Children and Families
of a child born out of wedlock.
of a child born out of wedlock.
of the
of a child born out of wedlock.
Plaintiff is:
mother
father
the
guardian
the
the
custodian
, is
(Zip)
(State)
(City/Town)
(Apt, Unit, No. etc.)
(Address)
Plaintiff, who resides at
The child who is the subject of this complaint is:
2.
Last Name
M.I.
First Name
(Zip)
(State)
(City/Town)
(Apt, Unit, No. etc.)
(Address)
Current age
Date of Birth
3.
is the
Defendant, who resides at
mother
father
of the above-named child who was born out of wedlock.
(Address)
(Apt, Unit, No. etc.)
(City/Town)
(State)
(Zip)
The plaintiff and defendant are not married.
The mother of the child was not married at the time of the child's birth and was not married within three hundred days
before the birth of the child.
4.
5.
Wherefore, the plaintiff requests that the Court:
adjudicate the
defendant
plaintiff
6.
to be the father of the child.
order a suitable amount of support for the child.
order the
defendant
plaintiff
to
provide
maintain
health insurance for the benefit of the child.
prohibit the defendant from imposing any restraint on the personal liberty of the
the child.
plaintiff
defendant
plaintiff
defendant
plaintiff
and/or
custody of the child.
grant the
parenting time with the child.
grant the
Date
Signature of Attorney or Plaintiff, if pro se
BBO No.:
Primary Phone #:
(Address Line)
(Apt, Unit, No. etc.)
(City/Town)
(State)
(Zip)
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