Form : R-132-00 Voluntary Acknowledgement Of Parentage
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2R-132-00
COMMONWEALTH OF MASSACHUSETTS - VOLUNTARY ACKNOWLEDGEMENT OF PARENTAGE
THIS IS A LEGAL DOCUMENT, PRINT OR TYPE IN PERMANENT BLACK INK.
We acknowledge that we are the biological parents of the following child (Name of child as it appears on the birth certificate.
First
Middle
Last
Sex (M/F)
Born in
on
Social Security #
(Place of Birth)
City/Town
State
Month - spelled out
Day
Year
(Child's SSN - If available)
We voluntarily sign this acknowledgement to establish the child's paternity. We understand that this acknowledgement may be used
to amend the child's birth certificate and the names of both parents will be on the child's birth certificate. We further understand
that this acknowledgement is a legal document with the same binding effect as a court judgment of paternity. Blood and genetic
tests may be used to deny paternity only in accordance with the terms described on the back of this form.
Name of child to appear on the amended birth certificate:
First
Middle
Last
(Name as it appears on the birth certificate.)
MOTHER
Name
First
Middle
Last
Maiden
Social Security #
Residence
No. & Street Name
City
State
Zip
Place of Birth
Date of Birth
City or Town
State
Country
Mo.
Day
Year
Check one:
I swear or affirm that when this child was born or within 300 days of the child's birth, I was not married.
I swear or affirm that when this child was born or conceived, I was married to someone other than the father of this child.
I understand that this form is not effective unless it is accompanied by an Affidavit of Nonpaternity signed by the man to whom I
was married to unless the court has determined that the man to whom I was married is not the child's father.
I understand that signing this form is voluntary and that paternity is established as of the date that both parents sign this form and
the acknowledgement is properly filed with the child's birth certificate. I have read and understand the information on both sides of
this form, including the information on the process for rescinding (canceling) this acknowledgement of paternity. I understand the
rights and responsibilities that result when both parents sign this form. I hereby swear or affirm under the penalties of perjury that
the information above is true to the best of my knowledge and belief.
Signature of Mother
Then personally appeared before me the above-named _______________________________and affirmed under penalties of perjury that
the foregoing is her free act and deed this ________day of ________________________, __________
FORM READ IN _______________
Notary Public:
My Commission Expires:
LANGUAGE
(Name as it appears on the birth certificate.)
FATHER
Name
First
Middle
Last
Maiden
Social Security #
Residence
No. & Street Name
City
State
Zip
Place of Birth
Date of Birth
City or Town
State
Country
Mo.
Day
Year
I understand that signing this form is voluntary and that paternity is established as of the date that both parents sign this form and
the acknowledgement is properly filed with the child's birth certificate. I have read and understand the information on both sides of
this form, including the information on the process for rescinding (canceling) this acknowledgement of paternity. I understand the
rights and responsibilities that result when both parents sign this form. I hereby swear or affirm under the penalties of perjury that
the information above is true to the best of my knowledge and belief.
Signature of Mother
Then personally appeared before me the above-named _______________________________and affirmed under penalties of perjury that
the foregoing is her free act and deed this ________day of ________________________, __________
FORM READ IN _______________
LANGUAGE
Notary Public:
My Commission Expires:
Page 1 of 2
Voluntary Acknowledgment of Parentage
c.g.f.
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