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Information about Voluntary Acknowledgment of Paternity. This information must be read to each

parent before it is signed and notarized.

A voluntary acknowledgment of paternity means that the parents freely admit who is the biological father of the child(ren).

If you do not know who is the father of the child(ren), you should seek genetic testing.

You, as the parent(s), have the right to talk with an attorney before signing.

By signing, you will give the child(ren) a legal record identifying each parent. This will enable the child(ren) to get access to

Social Security or veteran benefits, inheritance rights, life insurance and access to health insurance and medical information.

You, as the parent(s), have 60 days after signing a voluntary acknowledgment of paternity to change your mind and remove it

with a rescission form. Once the 60 days have passed, it can only be removed by going to court and proving that it was

signed on the basis of fraud, duress or material mistake of fact.

A voluntary acknowledgment of paternity does not involve custody or visitation rights. Parents must go to court for these.

Once you have signed this document, you, the parent(s), will be legally responsible for financially supporting the child(ren)

until at least age 18, and until age 19 if still in high school. You the parent(s) may also be required to pay for past medical

expenses, birth expenses and child support for the child(ren).

It is a crime for you to sign this form knowing that the man signing is not the biological father of the child(ren).

There will be a $60.00 fee to process any Acknowledgment of Paternity form filed after parent is discharged from the

hospital.

This form should NOT be signed if the mother was married at the time of either conception or birth, or between conception

and birth, or if a determination of paternity has been made by a court of competent jurisdiction.

I have been informed and understand my rights and responsibilities in signing a voluntary

acknowledgment of paternity for

(Full Name of Child as shown on Certificate of Birth)

born on

(MO,DAY,YR)

(Signature of Father)

(Signature of Mother)

Address of Father

Address of Mother

Dated this day

(Month, Day, Year)

Personally appeared before me the above-named and made

oath to the truth of the foregoing statements:

(Signature of Notary Public/Municipal Clerk)

My term expires:

State of

County of

City/Town of

S:vradminfAMaster formsVS27C R 11/2011

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Voluntary Acknowledgment Of Paternity - Maine Center For Disease Control And Prevention Page 2