ACKNOWLEDGMENT OF PATERNITY (Continued)
(Please type or print clearly in black ink.)
Case ID Number_______________________
Child’s Name (First, middle, last, suffix)
Date of Birth (mm/dd/yyyy)
STATEMENTS OF ACKNOWLEDGMENT
The statements of acknowledgment below must be read to each parent before it is signed, initialed and
notarized. Parents must initial each of the statements provided below in order for the AOP to be valid.
We understand we have the right to talk with an attorney before signing.
We understand once we have signed this acknowledgment, we will be legally responsible for financially supporting
this child until at least the age of 18, and until the age of 19 if still in high school. Parents may be required to pay
for past medical expenses, birth expenses and child support for this child.
We understand by signing this acknowledgment, we will give this child a legal record identifying each of us as
parents. This will enable this child to get access to Social Security or veteran benefits, inheritance rights, life
insurance and access to health insurance and medical information.
We understand the completion of an Acknowledgment of Paternity does not involve custody or visitation rights.
(Parents must go to court to gain rights.)
We understand it is a crime to sign this form knowing that the man signing is not the biological father of this child
and this document will be considered void if another man has already acknowledged paternity or if a court
determination has already been done to establish parentage.
We swear the man (father/parent) signing the acknowledgment believes himself to be the biological father of this
We understand that this acknowledgment is the equivalent of a court determination of paternity of this child and that
a challenge to the acknowledgment is permitted only under limited circumstances and is not allowed after two years.
We understand that we may rescind this acknowledgment by filing a Rescission form with the Office of Data,
Research, and Vital Statistics within 60 days after the Acknowledgment form has been filed and accepted.
We understand that after 60 days of filing the acknowledgment and a denial of parentage, if applicable, with the
Office of Data, Research, and Vital Statistics we must obtain a court determination to rescind or challenge the
acknowledgment or denial in order to remove or add a parent.
Parents must check one of boxes in the below statements in addition to initialing.
□ We acknowledge that the child subject to this AOP does not already have a presumed, acknowledged, or
□ We acknowledge that the child subject to this AOP already has a presumed father and does not have another
acknowledged or adjudicated father. It is understood that a Denial of Paternity (DOP) form from the presumed
father is required in order for this AOP to be valid.
The full name of the presumed father is: ______________________________________________________.
□ We acknowledge that there has not been genetic testing regarding this child’s paternity.
□ We acknowledge that there has been genetic testing and that the acknowledging man’s claim of paternity is
consistent with the results of the testing.
□ Single Mother
□ Married or Formerly Married Mother:
If the mother was married and the child was born within 300 days after the termination of the marriage, the
name of the spouse shall be entered on the child’s birth certificate unless paternity has been established.
If a DOP is not signed by the presumed father, do not proceed. The AOP and DOP may be filed
separately or simultaneously, but neither is valid until both are filed.
We have read and understand the instructions provided. We understand the legal consequences of and the rights and
responsibilities that arise from signing the acknowledgment. We have authenticated, under penalty of perjury the
above statements are correct to the best of our knowledge and belief.
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