Application For Search Of Ohio Putative Father Registry - Ohio Department Of Job And Family Services
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1
2
3Ohio Department of Job and Family Services
Ohio Putative Father Registry
rd
255 E. Main Street, 3
Floor
Columbus, Ohio 43215-5222
Phone: 1-888-313-3100
APPLICATION FOR SEARCH OF OHIO PUTATIVE FATHER REGISTRY
“Registration Form for Fathers”
The following information, if it is complete and submitted within 30 days of the child’s birth, will enable you to be
notified in the case of an adoption proceeding involving a child of whom you may be the father.
IDENTIFYING INFORMATION ABOUT THE FATHER:
Father’s
_________________________
____________
LAST Name ________________________________ FIRST Name
MIDDLE Name
Social Security Number
_______________________________
Phone Number (000/000/0000) _________________________
Date of Birth (MM/DD/YY) __________________________________
Race ________________________________________________
Other names by which father may be known:
____________________________________________________________________________________________________________________
Address Street Number _______________________________
Street Name _______________________________________________
State _____________________________ Zip ______________________
City __________________________________________________
Father’s Mailing Address/Apt. (If different than above)
Street Number_________________________________________ Street Name ________________________________________________
City ___________________________________________________ State _____________________________ Zip ______________________
IDENTIFYING INFORMATION ABOUT THE MOTHER:
Mother’s
_________________________
____________
LAST Name ________________________________ FIRST Name
MIDDLE Name
Social Security Number ___________________________________
Phone Number (000/000/0000) _________________________
Date of Birth (MM/DD/YY) __________________________________
Race ________________________________________________
Other names by which mother may be known:
___________________________________________________________________________________________________________________
Address Street Number ________________________________ Street Name ________________________________________________
State ____________________________ Zip ______________________
City __________________________________________________
Mother’s Mailing Address/Apt. (If different than above)
Street Number_________________________________________ Street Name _______________________________________________
City ___________________________________________________ State _____________________________ Zip ______________________
JFS 01694 (REV. 9/2003)
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