IN THE CIRCUIT COURT IN THE EIGHTEENTH JUDICIAL CIRCUIT IN AND FOR BREVARD COUNTY, FLORIDA. Case No.: __________________________________, Petitioner and , Respondent Bar Code Label FINAL JUDGMENT ON PETITION TO DISESTABLISH PATERNITY AND/OR CHILD SUPPORT OBLIGATION day of , 20 , upon This Cause came before the Court on the a Petition to Disestablish Paternity and/or Terminate Child Support under Chapter 742, Florida Statutes. Present before the Court were the [ ] Petitioner and [ ] Respondent. The Court having considered the testimony and evidence presented, makes these findings of fact and reaches these conclusions of law: 1. The Cou SECTION I. 1. THIS ACTION AFFECTS THE FOLLOWING CHILD(REN): Name Place of Birth Date of Birth 1.________________________ _________________ ________ 2.________________________ _________________ ________ 3.________________________ _________________ ________ 4.________________________ _________________ ________ 2. Sex ___ ___ ___ ___ PATERNITY. My paternity of the child(ren) was established by: {Check one only} Operation of law because I was married to the child(ren)'s mother. Adjudication of paternity entered by {court} on {date} , Case no.: . Administrative Order by Child Support Enforcement Office {Department of Revenue) entered at {location} on {date} , Case no.: . Acknowledgment of paternity executed on {date} . Other {specify} . A copy of the judgment and/or acknowledgment attached. Law 1116 ­ New 8-2010 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 3. CHILD SUPPORT. My child support obligation for the child(ren) was established by: {Check one only} A Final Judgment of Dissolution of Marriage, entered by {court} on {date} Case no.: . A Paternity proceeding is {court} , Case no.: . entered on {date} Administrative proceeding by the Department of Revenue, Child Support , at {location} Enforcement Office on {date} , Case no.: . Other {specify} . A copy of the judgment/order is attached. SECTION II. 1. NEWLY DISCOVERED EVIDENCE I hereby affirm that new discovered evidence concerning the paternity of this/these child(ren) has come to my knowledge, since the initial paternity determination or establishment of a child support obligation. {Explain} 2. SCIENTIFIC TESTING The results of scientific tests that are generally acceptable within the scientific community to show a probability of paternity, administered within 90 days prior to the filing of this petition, indicate that I cannot be the father of the child(ren) for whom support is required. A copy of the test results is attached. I did not have access to the child(ren) to have scientific testing performed before the filing of this petition and I request that the Court order the child(ren) to be tested. FULFILLMENT OF CHILD SUPPORT OBLIGATIONS {Check one only} I am current on all child support payments for the child(ren) whom relief is sought. I have substantially complied with my child support obligation for the child(ren) and any delinquency in my child support obligation for the child(ren) arose from my inability for just cause to pay delinquent child support when the delinquent child support became due. {Explain} 3. A current copy of my child support payment history is attached. Page 3 Law 1116 ­ New 8-2010 American LegalNet, Inc. www.FormsWorkFlow.com SECTION III. A. ALL OF THE FOLLOWING ARE TRUE TO THE BEST OF MY KNOWLEDGE {By initialing each statement below, I am affirming it to be true.} I have not adopted the child(ren). The child(ren) was/were not conceived by artificial insemination while I was married to the child(ren)'s mother. I did not act to prevent the biological father of the child(ren) from asserting his parental rights with respect to the child(ren). The child(ren) was/were younger than 18 years of age when the petition was filed. B. SINCE LEARNING THAT I AM NOT THE BIOLOGICAL FATHER OF THE CHILD(REN) I HAVE DONE NONE OF THE FOLLOWING: {By initialing each statement below, I am affirming it to be true.} I did not marry the mother of the child(ren) while known as the reputed father and voluntarily assumed the parental obligation and duty to pay child support. I have not acknowledged paternity of the child(ren) in a sworn statement. I have not consented to be named as the child(ren)'s biological father on the children's birth certificate(s). I did not voluntarily promise in writing to support the child(ren), and was not required to support the child(ren) based on any written promise. I have not disregarded a written notice from a state agency or any court directing me to submit scientific paternity testing. I have not signed a voluntary acknowledgment of paternity. PETITIONER'S REQUEST 1. I hereby request a hearing on this petition and understand that I must attend the hearing. 2. I am requesting that the Court enter an order to do the following: Disestablish paternity of the minor child(ren), ordering proper scientific testing if necessary. Terminate my obligation to pay prospective child support for the child(ren) named in this petition, including medical/dental insurance coverage for the minor child(ren). Change the child(ren)'s name(s) to the following: Law 1116 ­ New 8-2010 American LegalNet, Inc. www.FormsWorkFlow.com Page 4 I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Date:____________________________ Signature of Petitioner Printed Name_____________________________________ Address City, State, Zip Telephone number: STATE OF FLORIDA COUNTY OF BREVARD Sworn to (or affirmed) and subscribed before me this ____ day of _______________, 20___, ____________________________________ Signature of Notary Public-State of Florida Check one only: ___Personally known Type of I.D. produced__________________ _________________________________ Print, type or stamp Commissioned Name of Notary Public ___Produced I.D. IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [ fill in all blanks] , I, {full legal name and trade name of nonlawyer} a nonlawyer, located at {street} , {city}______________________, {state}______________, {phone}_______________, helped {Petitioner's name} __________________, _______________________________________, who is the [ one only] _____petitioner or _____ respondent, fill out this form. Law 1116 ­ New 8-2010 American LegalNet, Inc. www.FormsWorkFlow.com