IN THE JUVENILE COURT OF MEMPHIS AND SHELBY COUNTY, TENNESSEE Petitioner V. Docket Number Defendant PETITION TO ESTABLISH PARENTAGE To the Honorable Dan H. Michael, Judge of the Juvenile Court of Memphis and Shelby County, Tennessee: Your petitioner, , respectfully represents to the Court that the defendant is the mother/father of a child(ren) born out of wedlock and that is the mother/father of said child(ren). Your petitioner further avers PREMISES CONSIDERED, PETITIONER PRAYS: 1. That proper service of process issue requiring the defendant appear before this Court to answer this petition. 2. That the Court establish parentage of said child(ren). 3. That the Court determine custody and establish the support and maintenance of said child(ren) and such other expenses including medical as the Court may deem proper. 4. That the surname of said child(ren) be changed to that of the father. 5. For such other and further relief as may be within the jurisdiction of the Court and in the best interest of the child(ren). 6. Petitioner PA NPA STATE OF TENNESSEE COUNTY OF SHELBY AFFIDAVIT Address Before me personally appeared the petitioner in the foregoing petition, who makes oath that the statements therein are true to the best of her knowledge, information and belief. Petitioner Sworn to and subscribed before me this day of , 20 JANIS FULLILOVE, Clerk of Court By D. C. 09/01/18 JC-034 American LegalNet, Inc. www.FormsWorkFlow.com