The information and signature requirements for a fetal death paternity affidavit shall be as follows: the father's full name; the father's city or town, county, and state of residence; the father's date of birth; the father's social security number; the date and place of delivery of the fetus; the mother's full maiden name; the mother's social security number; the mother's resident address; the name of the fetus if it appears on the report of fetal death; the father's signature and the date signed; the mother's signature and the date signed; the mother's husband's signature in the case where the child's father is not the mother's husband; the signature of a parent or guardian if the natural father, the mother, or the mother's husband is not of legal age, and the date signed; and the signature and seal of a notary public or justice of the peace and the date signed.
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