§ Presumed Fathers Petition for Declaration of Non-Paternity
Presumed Father’s Petition for Declaration of Non-Paternity
[Publisher's note: Referenced interactive forms can be accessed at www.selfrepresent.mo.gov]
In what Missouri county will this case be In the Circuit Court of MISSOURI
filed?
If this is an amended petition, what is the case Case Number Division Number
number of the pending case?
Answer all questions on this form completely.
The Parties (1) I am filing this case and I am the PLAINTIFF. My name is:
______________________ ____________ _________________ _________
(First Name) (Middle Name) (Last Name) (Jr./Sr./III)
(2) The mother of the child(ren) listed below in (4) is a DEFENDANT in this case and her name is: (She
will be referred to as “ Mother” on these forms)
______________________ ____________ _________________
(Mother's First Name) (Middle Name) (Mother's Last Name)
(3) The following men are DEFENDANT(S) in this case. Either they--
• were married to the mother of the child(ren) listed below in (4) at the time of each child's birth, or
• were married to the mother of the child(ren) listed below in (4) within 300 days prior to each
child's birth, or
• are considered “presumed” fathers of the child(ren) listed below in (4) pursuant to § 210.822,
RSMo.
(They will be referred to as “First Presumed Father” and “ Second Presumed Father” on these
forms)
a. __________________ ____________ _________________ _________
(First Name) (Middle Name) (Last Name) (Jr./Sr./III)
b. __________________ ____________ _________________ _________
(First Name) (Middle Name) (Last Name) (Jr./Sr./III)
(4) I am NOT the father of the following minor child(ren) who are also DEFENDANT(S) in this case:
a. ________________________________________ Birth Date: __________
(Child's full name as it appears on the birth certificate) (mm/dd/ yyyy)
b. ________________________________________ Birth Date: __________
(Child's full name as it appears on the birth certificate) (mm/dd/ yyyy)
c. ________________________________________ Birth Date: __________
(Child's full name as it appears on the birth certificate) (mm/dd/ yyyy)
d. ________________________________________ Birth Date: __________
(Child's full name as it appears on the birth certificate) (mm/dd/ yyyy)
e. ________________________________________ Birth Date: __________
(Child's full name as it appears on the birth certificate) (mm/dd/ yyyy)
f. ________________________________________ Birth Date: __________
(Child's full name as it appears on the birth certificate) (mm/dd/ yyyy)
Presumed Father's Petition for Declaration of Non-Paternity--Page 1 of 7
Form CAFC303-01/01/ This form is available for free at www.selfrepresent.mo.gov
2011
(1) Your 5. My mailing address is:
Information
(Plaintiff) _______________________________________________________________
(Street)
_________________________ ___________________ _________________
(City) (State) (Zip)
________________________ ______________________________________
(Telephone Number) (E-Mail Address)
6. [ ] This is the first petition I have filed in this case. (Original Petition)
[ ] This is the second petition I have filed in this case.
[ ] This is the third petition I have filed in this case.
7. The last four numbers of my Social Security Number are: XXX-XX-_______________
8. I am _____ years old.
9. I reside in the Country of _______________.
10. II reside in the State of _______________.
11. I reside in the County of_______________--
Additional 12. [ ] I have NOT signed an affidavit
Allegations stating that I am the father of the child(ren).
[ ] I have signed an affidavit stating that I am the father of the child(ren). You must attach a copy of the
birth certificate and affidavit for each child.
13. I would also state and allege as follows: (Add any additional information which you believe might be
important.)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Presumed Father's Petition for Declaration of Non-Paternity--Page 2 of 7
Form CAFC303-01/01/ This form is available for free at www.selfrepresent.mo.gov
2011
(2) Mother's 14. Mother's mailing address is:
Information
(Defendant) _______________________________________________________________
(Street)
_________________________ ___________________ _________________
(City) (State) (Zip)
________________________ ______________________________________
(Telephone Number) (E-Mail Address)
15. The last four numbers of Mother's Social Security Number are:
XXX-XX-__________.
16. Mother is _____ years old.
17. Mother resides in the Country of _______________.
18. Mother resides in the State of _______________.
19. Mother resides in the County of _______________.
20. [ ] Mother is NOT on active duty in the United States military.
[ ] Mother is on active duty in the United States military.
21. [ ] Mother has signed a verified “Answer to Petition for Declaration of Non-Paternity”which is being
filed with this petition. Therefore, do not issue a summons.
[ ] Mother should be served at her residence.
_______________________________________________________________
(Street)
_________________________ ___________________ _________________
(City) (State) (Zip)
[ ] Mother should be served at her place of employment.
_______________________________________________________________
(Name of Employer)
_______________________________________________________________
(Street)
_________________________ ___________________ _________________
(City) (State) (Zip)
[ ] Service by publication. I don't know where Mother is and I have no way of locating her. Therefore, I am
requesting that she be served by publication.
[ ] Other method of service: _______________________________________________________________
Presumed Father's Petition for Declaration of Non-Paternity--Page 3 of 7
Form CAFC303-01/01/ This form is available for free at www.selfrepresent.mo.gov
2011
(3a) This is the person named on line 3a on the first page of this
Information petition
about the 22. First Presumed Father's mailing address is:
First
Presumed _______________________________________________________________
Father (Street)
(Defendant)
_________________________ ___________________ _________________
(City) (State) (Zip)
________________________ ______________________________________
(Telephone Number) (E-Mail Address)
23. The last four numbers of First Presumed Father's Social Security Number are:
XXX-XX-_______________
24. First Presumed Father is ___ years old.
25. First Presumed Father resides in the Country of _______________.
26. First Presumed Father resides in the State of _______________.
27. First Presumed Father resides in the County of _______________.
28. [ ] First Presumed Father is NOT on active duty in the United States military.
[ ] First Presumed Father is on active duty in the United States military.
29. [ ] First Presumed Father has signed a verified “Answer to Petition for Declaration of Non-Paternity”
which is being filed with this motion. Therefore, do not issue a summons.
[ ] First Presumed Father should be served at his residence.
_______________________________________________________________
(Street)
_________________________ ___________________ _________________
(City) (State) (Zip)
[ ] First Presumed Father should be served at his place of employment.
____________________________________________ __________________
(Employer's Name--if applicable) (Hours of Employment)
_______________________________________________________________
(Street)
_________________________ ___________________ _________________
(City) (State) (Zip)
[ ] Service by publication. I don't know where First Presumed Father is and I have no way of locating
him. Therefore, I am requesting that he be served by publication. I have filed an Affidavit for
Service by Publication and a Notice of Publication.
[ Other method of service:
] ____________________________________________________________
Presumed Father's Petition for Declaration of Non-Paternity--Page 4 of 7
Form CAFC303-01/01/ This form is available for free at www.selfrepresent.mo.gov
2011
(3b) This is the person named on line 3b on the first page of this
Information petition.
about the 30. Second Presumed Father's mailing address is:
Second
Presumed _______________________________________________________________
Father (Street)
(Defendant)
_________________________ ___________________ _________________
(City) (State) (Zip)
________________________ ______________________________________
(Telephone Number) (E-Mail Address)
31. The last four numbers of Second Presumed Father's Social SecurityNumber are:
XXX-XX-_______________
32. Second Presumed Father is ___ years old.
33. Second Presumed Father resides in the Country of _______________.
34. Second Presumed Father resides in the State of _______________.
35. Second Presumed Father resides in the County of_______________--
36. [ ] Second Presumed Father is NOT on active duty in the United States military.
[ ] Second Presumed Father is on active duty in the United States military.
37. [ ] Second Presumed Father has signed a verified “Answer to Petition for Declaration of
Non-Paternity” which is being filed with this motion. Therefore, do not issue a summons.
[ ] Second Presumed Father should be served at his residence.
_______________________________________________________________
(Street)
_________________________ ___________________ _________________
(City) (State) (Zip)
[ ] Second Presumed Father should be served at his place of emplo yment.
____________________________________________ __________________
(Employer's Name--if applicable) (Hours of Employment)
_______________________________________________________________
(Street)
_________________________ ___________________ _________________
(City) (State) (Zip)
[ ] Service by publication. I don't know where Second Presumed Father is and I have no way of
locating him. Therefore, I am requesting that he be served by publication. I have filed an Affidavit
for Service by Publication and a Notice of Publication.
[ Other method of service:
] ____________________________________________________________
Presumed Father's Petition for Declaration of Non-Paternity--Page 5 of 7
Form CAFC303-01/01/
2011 This form is available for free at www.selfrepresent.mo.gov
38. [ ] The parent receiving support is not receiving public assistance.
Family
Support
[ ] I don't know if the parent receiving support is receiving public assistance.
Division [ ] The parent receiving support is receiving public assistance and therefore the State of Missouri must
be served. Summons to issue to be served on:
Director, Family Support Division
615 Howerton Court
Jefferson City, Missouri 65102
Additional
Information
about the
39. The child(ren) have lived with the following persons at the following address(es) during the past five
years. (State the dates at each address)
Children _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
40. Check all boxes that apply to your case.
[ ] Someone other than me or the other parent has physical custody of one or more of the child(ren) or
claims to have custody or visitation rights with respect to one or more of the child(ren).
[ ] There are other custody proceeding(s) concerning one or more of the child(ren) pending in a court
of this or another state.
[ ] I have participated in other litigation concerning the custody of one or more of the child(ren) in this
or another other state.
[ ] One or more of the child(ren) has been a victim of abuse or neglect.
41. Explanation: (If you checked any of the boxes in paragraph 40, please explain in detail here.)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Presumed Father's Petition for Declaration of Non-Paternity--Page 6 of 7
Form CAFC303-01/01/ This form is available for free at www.selfrepresent.mo.gov
2011
Request for
Relief
THEREFORE, I am requesting that the court find and declare that I am not the father of the child(ren) listed in
paragraph (4) of this petition. I also request that the court appoint a guardian ad litem for the child(ren).
I also request the following relief:
[ ] I am without sufficient funds to pay for my attorney and I request that the other party pay my
ttorney's fees for this case.
[ ] Other (Please state the other requests)
_______________________________________________________________
_______________________________________________________________
Plaintiff, being of lawful age and duly sworn on his oath, states that he is the plaintiff named above and that the facts stated in this Petition for Declaration of Non-Paternity are true according to his best knowledge and belief.
____________________________________ ____________________________________
SIGN HERE PRINT YOUR NAME HERE
Subscribed and sworn to this ___ day of __________, 20 ___.
__________________________
Notary Public (Sign this in front of a Notary Public) (This should only be completed if a
lawyer helped you with this form)
My Commission Expires:
__________________________
ATTORNEY INFORMATION (To be completed by your attorney) Do not enter any information here if
you are
___________________________ _____________________ filing this case without
Attorney--SIGN HERE Missouri Bar Number the assistance of a lawyer.
__________________________________________________ This information should be
Attorney for Plaintiff--PRINT YOUR NAME HERE completed by your attorney.
__________________________________________________
(Street) [ ]I have assisted Plaintiff
in the preparation of these
_______________________________ ___________ _____ pleadings, but I am not
(City) (State) (Zip) entering my appearance on behalf of
Plaintiff.
________________ ____________ ___________________
(Telephone Number) (Fax Number) (Email Address)
Presumed Father's Petition for Declaration of Non-Paternity--Page 7 of 7
Form CAFC303-01/01/ This form is available for free at www.selfrepresent.mo.gov
2011
[Publisher's note: Referenced interactive forms can be accessed at www.selfrepresent.mo.gov]