State Of Colorado - Voluntary Acknowledgment Of Paternity Template (Page 2 of 2) in pdf

Advisement to Unmarried Parents

If the mother and father of the child are not married it is important for the parents to acknowledge paternity of the child. The following is information about acknowledg-

ing paternity and the rights and responsibilities that are connected to acknowledging paternity.

When the Acknowledgment of Paternity is signed, the mother and father are agreeing that they are aware of the following:

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The mother and father have signed the Acknowledgment of Paternity of their own free will.

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The mother and father understand that acknowledging paternity means they are saying they are the mother and the father of the named child for all purposes.

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The Acknowledgment of Paternity establishes a legal parent/child relationship.

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The Acknowledgment of Paternity may be used in any legal actions about the child.

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The mother and father know they may have to pay financial and medical support for the child.

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After signing the Acknowledgment of Paternity, the father’s name will be put on the child’s birth certificate.

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The Acknowledgment of Paternity does not give either the mother or the father custody or visitation rights. They will have to go to court for these and other

rights or responsibilities to be decided.

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The mother and/or the father may choose not to acknowledge paternity.

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The mother and/or the father have the right to talk to an attorney, have an attorney represent them, have genetic tests done, ask the court to decide on pater-

nity and/or acknowledge paternity later. The mother and/or the father have the right to know about any court hearing on paternity and may take witnesses to

court and cross examine witnesses.

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The mother and/or the father may change their mind about acknowledging paternity after signing this form. Under Colorado law, the Acknowledgment of

Paternity will be a legal finding of paternity within sixty days after the mother and father sign it. If either the mother or the father changes their mind, they must

contact their county Child Support Enforcement office or a private attorney or the court within 60 days after signing it or before any legal action is taken with

the child and the parent(s), whichever is first. Genetic tests for paternity may be done and the mother or the father may have to pay for the genetic tests.

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The rights and responsibilities connected to acknowledging paternity are recorded and may be heard on the telephone numbers below:

Telephone Number for calls within the Denver-Metro Area: 303 894-2088

Toll-free Telephone Number for calls Outside of the Denver-Metro Area: 1-888-839-3494

Available 24 hours per day, 7 days per week

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There is no charge to you for processing this form if it is completed at the hospital with the original Certificate of Live Birth. Leave this form with the hospital

staff or midwife who will submit it to the Colorado Vital Records Section for you.

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If this form is completed after the deadline for completing the Certificate of Live Birth, take or mail this form for approval to the Colorado Modification Section

at the address below. There is a $20.00 charge to add the father’s name to the birth certificate. If you want a copy of the birth certificate with the father’s name

added, the fees are $17.75 for the first copy and $10.00 for each additional copy of the same record ordered at the same time. Return this witnessed form

along with the fee, a copy of the requesting parent’s acceptable form of ID and a long self-addressed stamped envelope to the address listed below.

Advisement to Hospital

Colorado Statute § 25-2-112 Section 9.2 states that if the mother was not married at the time of conception or birth the name of the father shall be entered if the

mother and the person to be named as the father so request in writing on a form prescribed and furnished by the State Registrar - Acknowledgment of Paternity.

This is a legal document which will be used to add the father’s information to the child’s birth certificate. The information must be printed clearly and in black ink.

Crossouts and/or white out are not acceptable.

Mother Refusing to List Husband

If the mother was married at the time of conception or birth, or any time in between, and is refusing to list a father, the mother must complete Section A & B. In Sec-

tion D, write “refused” across the (ex) husband’s area. If mother is not present to sign, the registrar may sign Section D.

Please return this witnessed form to the Colorado Vital Records at the address listed below:

cOLORADO DEPARTMENT OF PUBLIc HEALTH & ENVIRONMENT

Modification Unit - Paternity - HSVR-VR-A1

4300 cherry creek Dr South

Denver, cO 80246-1530

303 692-2230

Section for the witness is mandatory.

PLEASE BE ADVISED THAT THERE ARE PENALTIES INcLUDINg THOSE PURSUANT TO

c.R.S. 18-5-114

FOR FALSELy wITNESSINg THIS DOcUMENT

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