Date.

and do not recognise the sacrament of baptism, and that the name

are the parents of the said child.

was given to

Take notice, that the court of session (or other competent court) upon the

day of

18 , pronounced decree in an action before the said Court at the instance of

(pursuer's name and description), against (defendant's name and description), relating to the paternity

18

, finding that the said child was the illegitimate child of the said (names

, that I last saw the deceased on the

, and that the cause of death and duration of disease were as