Affidavit Of Parentage Page 2
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4Form 34A: Affidavit of Parentage
(page 2)
Court File Number
Check off all boxes below that apply to your situation.
7.
The review mentioned in paragraph 6 included an examination of the following checklist:
(a) Within the 300-day period before the child’s birth,
the mother’s husband
died.
(husband’s full legal name)
the mother got a divorce or annulment from
(spouse’s full legal name)
the mother’s cohabitation with
(man’s full legal name)
that lasted for a period of
(State duration of relationship.)
came to an end.
the mother was not cohabiting with anyone in a relationship of some permanence.
(b) At the time of the child’s birth, the child’s mother was
not married.
married to
(husband’s full legal name)
not cohabiting with any man.
cohabiting with (man’s full legal name)
for a period of
(State duration of relationship.)
(c) After the child’s birth, the child’s mother
remained unmarried to this day, to the best of my knowledge and information.
was married to a man who has never acknowledged that he is the father of the child.
was married on
to
(date of marriage)
, who acknowledged that
(husband’s full legal name)
he is the father of the child.
(d) Under Ontario’s Vital Statistics Act or under similar legislation in another province or territory in Canada,
no man, to the best of my knowledge and information,
(man’s full legal name)
has certified the child’s birth as the child’s father.
(e) As of today’s date,
no man has, to the best of my knowledge and information, been recognized by a court in Canada
has been recognized
(man’s full legal name)
by
(name of court)
to be the father of the child.
(f) In the 12 months before the child was placed for adoption,
no person
(person’s full legal name)
has demonstrated a settled intention to treat the child as a child of his or her own family.
FLR-34A-E (2005/09)
Page 2 of 4
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