Determination Of Paternity Form 1998 Page 2
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1
2INSTRUCTIONS FOR DETERMINATION OF PATERNITY
NAME OF CHILD FROM ORIGINAL BIRTH RECORD:
Enter exact spelling of Child's first,
middle and last name from original birth certificate.
NAME OF CHILD AFTER DETERMINATION OF PATERNITY:
Enter exact spelling of
Child's first, middle and last name including suffix (if any e.g. Jr., 11) to be put on the new
birth
certificate.
PLACE OF BIRTH (CITY, COUNTY, STATE):
Enter City, County or State of the Child's
birth.
DATE OF BIRTH (MONTH, DAY, YEAR):
Enter the Month, Day and Year of the Child's
birth.
SEX:
Enter the sex of the Child at birth.
MOTHER'S MAIDEN NAME:
Enter the Mother's first, middle and Maiden last name.
MOTHER'S PRESENT NAME:
Enter the Mother's present name including her first, middle
and last name.
FULL NAME OF FATHER:
Enter the Father's first, middle and last name including suffix (if
any).
PLACE OF BIRTH (STATE OR FOREIGN COUNTRY):
Enter Father's place of birth.
Include only the State of Foreign Country of birth.
DATE OF BIRTH:
Enter the Father's full date of birth including Month, Day and Year.
RACE (AMERICAN INDIAN, BLACK, WHITE, ETC.):
Enter the Father's race.
ORIGIN OR DESCENT (ITALIAN, MEXICAN, GERMAN, ENGLISH, CUBAN, PUERTO
RICAN, ETC.):
List Father's origin or descent, if unknown, enter unknown.
OF HISPANIC ORIGIN? YES OR NO (IF YES, SPECIFY CUBAN, MEXICAN, PUERTO
RICAN, ETC.):
Enter either NO or YES, if YES specify which origin, if unknown, enter
unknown.
USUAL OCCUPATION:
Enter Father's usual occupation at the time of the Child's birth, if
unknown, enter unknown.
KIND OF BUSINESS OR INDUSTRY:
Enter Father's type of business or industry, if
unknown, enter unknown.
EDUCATION (HIGHEST GRADE COMPLETED) ELEMENTARY OR SECONDARY
COLLEGE 1-4 OR 5+:
Enter Father's highest grade completed. If high school graduate or
GED, enter 12. For college, enter the number of years in college, if 5 years or more enter 5+.
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