*03PA001E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES Mother's Affidavit of Paternity (One affidavit for each father) OFFICE USE ONLY Name: Case no.: Court case no.: OK IV-D case no.: I swear that is the father of: Child(ren)'s name State of birth Date of birth and I am the natural mother. I understand that genetic testing may be used to determine who the father of the child(ren) is and I agree to submit myself and my child(ren) to this testing as necessary. I understand the penalty for perjury on a document that is going to be used in a judicial proceeding is five years in prison and a $1000 fine. I state under penalty of perjury under the laws of Oklahoma that the foregoing is true and correct. Please sign and date the form and have it witnessed. Date Signature of mother Witness If you cannot truthfully swear who is the father of the children, please state why: Mail this form to your Oklahoma Department of Human Services (OKDHS) county office. The OKDHS county office forwards Form 03PA001E to the appropriate OKDHS Child Support Enforcement Division (CSED) district office. OKDHS revised 7-1-2004 03PA001E (CSED-1-B) Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com 03PA001E (CSED-1-B) Mother’s Affidavit of Paternity Purpose of form Form 03PA001E is completed, signed, and dated by the mother of a child(ren) for whom paternity has not been established. Depending upon the circumstances, Form 03PA001E may not be the only form required to establish and enforce child support orders. Instructions for preparation of form 1. Use a black ink pen to complete Form 03PA001E. 2. Complete one Form 03PA001E for each father. 3. Sign and date Form 03PA001E in the presence of a witness and have that person sign Form 03PA001E in the space provided next to the mother’s signature. 4. Return the original Form 03PA001E to the Oklahoma Department of Human Services (OKDHS), Family Support Services (FSS) intake worker. The FSS intake worker forwards Form 03PA001E to the appropriate OKDHS Child Support Enforcement Division (CSED) district office. 5. If Form 03PA001E is not completed at the time of application for services, it must be completed and returned within ten days of the notice of certification for services. Page 2 of 2 OKDHS revised 7-1-2004 American LegalNet, Inc. www.FormsWorkflow.com