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Get MA R-134-00

R within 300 days of conception is not the father of the following child: First Name Middle Name Last Name who was born in Sex (M/F) on (Place of Birth) City/Town/State (Date of Birth) Month-spelled out Day Year Affidavit of Mother and Presumed Father (husband at time of child's birth or within 300 days of the birth): - MOTHER First Name Middle Name Last Name - Social Security # PRESUMED FATHER First Name Middle Name Born in Last Name - Social Security # on City/State/Co.

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