Fetal Death Paternity Affidavit

The information and signature requirements for a fetal death paternity affidavit shall be as follows: I. Information regarding the fetus and delivery: (a) The name of the fetus as it appears on the report of fetal death. (b) The date and place of delivery of the fetus. II. Information regarding the father: (a) Current full legal name. (b) Full name prior to first marriage or civil union. (c) Residence address, including street address, city or town, state, and zip code. (d) Date of birth. (e) State of birth. (f) Father's signature and date signed, unless the natural father is a minor, in which case his parent or guardian's signature and date signed shall be obtained. III. Information regarding the mother: (a) Current full legal name. (b) Full name prior to first marriage or civil union. (c) Residence address, including street address, city or town, state, and zip code. (d) Date of birth. (e) State of birth. (f) Mother's signature and date signed, unless the mother is a minor, in which case her parent or guardian's signature and date signed shall be obtained. IV. Information regarding the mother's partner, when they agree that they are not a natural parent of the fetus: (a) Current full legal name. (b) Partner's signature and date signed, unless the partner is a minor, in which case their parent or guardian's signature and date signed shall be obtained. V. The signatures of the natural father, mother, and, if applicable, partner shall be notarized.