Affidavit Of Parentage Page 3

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Form 34A: Affidavit of Parentage
(page 3)
Court File Number
(g) In the 12 months before the child was placed for adoption,
no person has acknowledged to me or, to the best of my knowledge and information, to any other person or
agency
(person’s full legal name)
acknowledged
to me
to
(name of other person or agency)
parentage of the child and provided for the child’s support.
(h) A statutory declaration
has, to the best of my knowledge and information, never been filed by any person,
was filed by
(person’s full legal name)
with the office of the Registrar General acknowledging parentage of the child.
(i) There is
no written agreement or court order requiring any person,
, at
a written agreement made on
(date)
(municipality, etc.)
,
requiring
(person’s full legal name)
,
an order of
, made
(name of court)
on
(date)
, at
(municipality, etc.)
,
requiring
(person’s full legal name)
,
to provide for the child’s support.
(j) There is
no written agreement or court order giving any person,
, at
a written agreement made on
(date)
(municipality, etc.)
,
giving
(person’s full legal name)
,
, made
an order of
(name of court)
on
, at
(date)
(municipality, etc.)
,
giving
(person’s full legal name)
,
custody of or access to the child.
FLR-34A-E (2005/09)
Page 3 of 4

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