Acknowledgement Of Paternity Template printable pdf download

Acknowledgement Of Paternity Template

Acknowledgement of Paternity

Child

Full Birth Name:

DOB:

Sex:

Race:

Birth City:

Birth State:

Attending Physician:

Hospital:

Hospital Address:

Birth Certificate No.:

SSN:

Mother

Full Maiden Name:

Full Current Name:

DOB:

Race:

Birth City:

Birth State:

Birth Certificate No.:

SSN:

Employer:

Title:

Biological Father

Full Name:

DOB:

Race:

Birth City:

Birth State:

Birth Certificate No.:

SSN:

Employer:

Title:

Biological Parents’ Marriage

Marriage Date:

Place:

Marriage Certificate No.:

Divorced?

Father’s Address:

Mother’s Address:

We, the aforementioned mother and father, do hereby swear and attest that the information listed above is true and factual, and that we

are the biological parents of the child. We request that the father listed above be named on the child’s official birth certificate.

Mother’s Signature

Date

Father’s Signature

Date

This document was acknowledged before me on

[Date] by

[Name of principal].

[Notary Seal, if any]:

(Signature of Notarial Officer)

Acknowledgement Of Paternity Template

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