Form 154 Rev 2/19 The Family Court of the State of Delaware In and For New Castle Kent Sussex County AFFIDAVIT OF PARENTAGE Petitioner Respondent In the interest of DOB: City and State of Birth: 1. Who is the child222s birth mother? Petitioner Respondent O ther: If Other, provide address: 2 . Genetic Testi ng ordered by any c ourt or any state agency : Has never been conducted; or May have been conducted but I do not know the result; or Excluded as a parent of this child; or Established as a likely parent of this child by a 99% or greater probability. 3. On the line provided identify any person for whom any of the following applies or indicate 223not applicable224 or 223unknown224: has been identified as a parent by a Court or administrativ e order in any legal proceeding. has signed a Voluntary A c knowledgement of P aternity (VAP) on file with an Office of Vital Statistics. has be en identified as a parent on the child222s official birth registration. participated in assisted reproduction intending to become a legal parent of this child. resided in same household and held the child out as thei r own for 1 st 2 years of child222s life. 4. Was this child born during a marriage or civil union or within 300 days after divorce or dissolution? YES NO UNKNOWN If 223yes224 : W hat is the name o f the birth mother222s spouse (or ex - spouse)? Has the spouse openly held this child out as his or her own? YES NO UNKNOWN Did Mother and Husband (if applicable) cohabitate or engage in sexual intercourse with each other during the probable time of conception? YES NO UNKNOWN 5. State the name and address (if known) of any person identified in paragraph 3 or 4 who is not already a party to this petition: COMPLETE ONLY IF YOU ARE THE CHILD222S MOTHER 6 . I am the child222s mother and I believe the child222s biological father is . 7 . From 300 days prior to my child222s birth to the time I first learned I was pregn ant, the person identified in paragraph 6 was: The only person with whom I had sexual intercourse; (or) Not the only person with whom I had sexual intercourse. I conceived my child by assisted reproduction and an anonymous sperm donor. I choose to not answer this question and request that genetic testing be ordered to determine parentage. I SWEAR (or) AFFIRM under penalty of perjury that the above information is true and correct to the best of my belief. PETITIONER / RESPONDENT PRINT NAME Sworn to and subscribed before me this day of , Notary / Clerk of Court Date Name Name File Number Relationship to C hild: Relationship to C hild: Petition Number American LegalNet, Inc. www.FormsWorkFlow.com