Dss Form 1548 - Responsible Father Registry Notice Of Change - South Carolina Department Of Social Services Page 2

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PART 3 – CHILD’S INFORMATION
A. Information Change
Child’s First Name
Middle
Last
Date of Birth
Sex:
Male
Female
Place of Birth (City, State, County)
Hospital
PART 4 – SIGNATURE
I am on notice of the following penalty in SC Code Section 63-8-820(R) (2) for filing false claims: “A person who
knowingly, maliciously, or in bad faith files a false claim of paternity with the registry is guilty of a misdemeanor and,
upon conviction, must be fined not more than five hundred dollars or imprisoned for not more than thirty days, or both.”
Signature of Father
Date
Mail this form to: South Carolina Department of Social Services, Responsible Father Registry
P.O. Box 1520
Columbia, SC 29202
DSS Form 1548 (APR 10)
PAGE 2

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