Acknowledgment Of Paternity Inquiry Request Form printable pdf download

Acknowledgment Of Paternity Inquiry Request Form

ACKNOWLEDGMENT OF PATERNITY

Budget: ZZ712

INQUIRY REQUEST FORM

Fee Received: ______

___ Positive Search

___ Negative Search

Date Mailed/ Fax: _______

The AOP Registry only includes Acknowledgments of Paternity filed from September 1,

1999 to the present.

Name of Child: ________________________________________ Date of Birth:_______

City or County of Birth: ________________________________

Mother’s complete name: _______________________________ Date of Birth:________

Biological Father’s name: _______________________________ Date of Birth:________

Name and address of Person making the Inquiry:

First

Middle

Last

Address

City

State

Zip Code

(

)

(

)

Daytime Telephone Number

Fax number

Family Code §160.313 limits access to AOP’s to the following individuals/agencies:

Relationship: ___ Mother ___ Father ___ Presumed Father ___Court Ordered for Attorney

Release: I authorize you to give the copy of the above-identified Acknowledgment of Paternity

form to:

_____________________________________________________________________________

___________________________________________

______________

SIGNATURE OF REQUESTOR

DATE

This inquiry request requires a search fee. A copy of government issued identification is required. If paying by

credit card, the fee is $12.25. If paying by check or money order, the fee is $10.00. Make check or money order

payable to Texas Department of State Health Services (DSHS) -ZZ712. Mail completed form and fee to the

address below. This inquiry may also be faxed to 512-458-7233 and paid with a MasterCard, Visa, Discover, or

American Express.

If faxed: ___M/C ___VISA ___DISCOVER

ACCT # ______________________________________ EXP DATE ________________

___American Express

NAME OF CARDHOLDER __________________________________________________

Mail To:

CARDHOLDER ADDRESS__________________________________________________

AOP Registry

Vital Statistics Unit, MC 1966

_________________________________________

P.O. BOX 12040

Austin, Texas 78711-2040

3 - DIGIT SECURITY CODE _______________(Found on back of card)

CARDHOLDER PHONE NUMBER,

INCLUDING AREA CODE___________________________________________________

Acknowledgment Of Paternity Inquiry Request Form

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