Affidavit Of Parentage
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4ONTARIO
Court File Number
(Name of Court)
Form 34A: Affidavit of
Parentage,
at
sworn/affirmed
Court office address
Applicant(s) (If the applicant is unknown at the time this affidavit is sworn/affirmed or if the applicant’s name is not to be
disclosed to the person swearing/affirming this affidavit, leave this box blank)
Full legal name & address for service — street & number, municipality,
Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any).
code, telephone & fax numbers and e-mail address (if any).
Respondent(s) (If there is a respondent, the first letter of the respondent’s surname may be used)
Full legal name & address for service — street & number, municipality,
Lawyer’s name & address — street & number, municipality, postal
postal code, telephone & fax numbers and e-mail address (if any).
code, telephone & fax numbers and e-mail address (if any).
My name is
(full legal name)
I live in
(municipality & province)
and I swear/affirm that the following is true:
1.
The child's full legal name is:
(Give full legal name, date of birth, sex and birth registration number if known of person to be adopted. If
this person was placed for adoption by a licensee or children’s aid society, you may use an initial for the surname.)
Full legal name
Date of birth
Sex
Birth registration number
2.
I am
(State your relationship to the child.)
3.
The child was born on
, in (municipality,
(date)
province, etc.)
4.
The child’s birth was registered or registration has been requested with the vital statistics register of
(province)
under the following name(s):
Check applicable box(es).
5.
The child’s biological father is
(father’s full legal name)
I do not know the identity of the child’s biological father. The only information that I have about his identity is as follows:
(Give what information you have about who the father might be.)
6.
(Name of person familiar with legal meaning of “parent”)
has reviewed with me those categories of persons who qualify as “parents” for the purposes of the Child and Family
Services Act and whose consents have to be obtained or dispensed with before the child can be adopted.
FLR-34A-E (2005/09)
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