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Here is the text we could read:

1. Provide the following information about the father:

Date of birth 

Full legal name

Physical description

Address

Telephone no.

E-mail address

2. Why do you believe this man to be a possible father of the child?

3. Write a brief history of your relationship with the father.

 

 

 

 

 

 

 

 

 

 

 

   

 

 

 

 

4. State the approximate date and place of conception. 

 

5. Did the father know you were pregnant? 

 Yes 

 No

6. Has the father established a custodial relationship with the child? 

 Yes 

 No

7. Has the father provided substantial and regular support or care in accordance with his ability to provide such support or care
 

for you during your pregnancy? 

 Yes 

 No

8. Has the father provided substantial and regular support or care in accordance with his ability to provide such support or care
 

for you or the child after the child’s birth during the 90 days before the date of this affidavit? 

 Yes 

 No

PCA 356a (6/17)  ADDENDUM A TO VERIFIED DECLARATION ABOUT PATERNITY            (Father’s Name and Whereabouts Known)MCL 710.39Approved, SCAOSTATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTY ADDENDUM A TO VERIFIED DECLARATION ABOUT PATERNITY(Father’s Name and Whereabouts Known)FILE NO.Note: Attach this addendum to form PCA 356.

PCA 356a, Addendum A to Verified Declaration About Paternity (Father's Name and Whereabouts Known)

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About This Form:

Sourced from www.courts.michigan.gov/adoptions-court-forms (2023-03)
Page(s): 1
Fields(s): 26
Average fields per page: 26
Reading Level: Grade 11
LIST Grouping(s): FA-00-00-00-00, ES-00-00-00-00, ES-02-00-00-00, FA-14-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

stat_e_n_l_county was STATE OF MICHIGAN JUDICIAL CIRCUIT FAMILY DIVISION COUNTY (0.64 conf)
fil_e was FILE NO (0.48 conf)
users1_name was Full legal name (1.00 conf)
users1_birthdate was Date of birth (1.00 conf)
physical_description was Physical description (0.43 conf)
users1_address_line_one was Address (1.00 conf)
telephone was Telephone no (0.44 conf)
users1_email was Email address (1.00 conf)
believe_man_possible_child__1 was 2 Why do you believe this man to be a possible father of the child 1 (0.42 conf)
believe_man_possible_child__2 was 2 Why do you believe this man to be a possible father of the child 2 (0.42 conf)
believe_man_possible_child__3 was 2 Why do you believe this man to be a possible father of the child 3 (0.42 conf)
write_brief_relationship__1 was 3 Write a brief history of your relationship with the father 1 (0.31 conf)
write_brief_relationship__2 was 3 Write a brief history of your relationship with the father 2 (0.31 conf)
write_brief_relationship__3 was 3 Write a brief history of your relationship with the father 3 (0.31 conf)
write_brief_relationship__4 was 3 Write a brief history of your relationship with the father 4 (0.31 conf)
write_brief_relationship__5 was 3 Write a brief history of your relationship with the father 5 (0.31 conf)
state_date_place was 4 State the approximate date and place of conception (0.34 conf)
text was Text1 (0.35 conf)
check_box__1 was Check Box2 (0.37 conf)
check_box__2 was Check Box3 (0.37 conf)
check_box__3 was Check Box4 (0.37 conf)
check_box__4 was Check Box5 (0.37 conf)
check_box__5 was Check Box6 (0.37 conf)
check_box__6 was Check Box7 (0.37 conf)
check_box__7 was Check Box8 (0.37 conf)
check_box__8 was Check Box9 (0.37 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

PCA 356a, Addendum A to Verified Declaration About Paternity (Father's Name and Whereabouts Known)

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02