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FORM 12.981(a)(3),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.981(a)(3),
AFFIDAVIT OF NONPATERNITY (03/15)
When should this form be used?
This form should be used when a stepfather is adopting his wife’s minor child and the mother and father of
the minor child(ren) were never married and paternity has not been established by a valid acknowledgment
or court order. This Affidavit of Nonpaternity may be used instead of a consent form. This Affidavit may be
executed before the birth of the minor child. The person signing the affidavit waives notice to all court
proceedings after the date it is signed. After signing this affidavit, it may only be withdrawn if the court finds
the affidavit was obtained by fraud or duress.
This form should be typed or printed in black ink. This form must be signed before a notary public or deputy
clerk and two witnesses other than the notary or clerk. You should then file the original of this form with the
Joint Petition for Stepparent Adoption, Florida Supreme Court Approved Family Law Form 12.981(b)(1).
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that petitions, pleadings, and documents be filed
electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings electronically; however, they are not required to do so. If you choose to file your pleadings or
other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration
2.525, and you must follow the procedures of the judicial circuit in which you file. The rules and procedures
should be carefully read and followed.
Special Notes
Remember--a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out these
forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules of
Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms also
must put his or her name, address, and telephone number on the bottom of the last page of every form he
or she helps you complete.
Instructions for Florida Supreme Court Approved Family Law Form 12.981(a)(3), Affidavit of Nonpaternity (03/15)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR __ COUNTY, FLORIDA
Case No.:
Division:
IN THE MATTER OF THE ADOPTION OF
___________________________________________,
{use name to of the minor child(ren)}Adoptee(s)
AFFIDAVIT OF NONPATERNITY
I, {full legal name} , have personal knowledge of the facts
stated in this affidavit and certify that the following statements are true:
1. I have been told that {name} has a child. I do not wish to
and shall not establish or claim paternity for this child, whose name is ___________________
and whose date of birth is_____________________________.
2. The child referenced in this affidavit was not conceived or born while the birth mother was
married to me. I AM NOT MARRIED TO THE BIRTH MOTHER, nor do I intend to marry the birth
mother.
3. The child has not been established to be my child in any court proceeding and I have not adopted
this child.
4. I have no interest in assuming the responsibilities of parenthood for this child. I have not
acknowledged and will not acknowledge in writing that I am the father of this child or will not
institute court proceedings to establish the child as mine.
5. I do not object to any decision or arrangements the birth mother makes regarding this child,
including adoption.
6. I understand my right to choose a person who does not have an employment, professional, or
personal relationship with the adoption entity or the prospective adoptive parents to be present
when this affidavit is executed and to sign it as a witness. The witness I selected is {full legal name}
.
7. I am executing this affidavit freely and voluntarily and I understand that it can only be withdrawn if
the court finds it was executed by fraud or duress.
I WAIVE NOTICE OF ANY AND ALL PROCEEDINGS TO TERMINATE PARENTAL RIGHTS OR FINALIZE AN
ADOPTION UNDER CHAPTER 63, FLORIDA STATUTES.
Florida Supreme Court Approved Family Law Form 12.981(a)(3), Affidavit of Nonpaternity (03/15)
_________________________________________
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this
affidavit and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.
Signature
Printed Name: __________________________________
Address: _______________________________________
City, State, Zip: _________________________________
Designated E-mail Address(es):_____________________
Signature of Witness
Signature of Witness
Printed Name:
Printed Name:
Business Address:
Business Address:
Home Address:
Home Address:
Driver’s License or
Driver’s License or
State ID Card No.:
State ID Card No.:
STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed and signed before me on {date
} .
NOTARY PUBLIC or DEPUTY CLERK
[Print, type, or stamp commissioned name of notary or
deputy clerk.]
_____Personally known
_____Produced identification
Type of identification produced
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) parent or ( ) stepparent
This form was completed with the assistance of:
{name of individual}_________________________________________________________________,
{name of business} ___________________________________________________________________,
{address} ___________________________________________________________________________,
{city} ________________, {state} ____, {zip code}_________{telephone number} ________________.
.
Florida Supreme Court Approved Family Law Form 12.981(a)(3), Affidavit of Nonpaternity (03/15)
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FORM 12.981(a)(3),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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Completed 10 January 2021

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