Order Acknowledging Paternity - State Of Rhode Island And Providence Plantations Family Court
ADVERTISEMENT
1
2STATE OF RHODE ISLAND
AND PROVIDENCE PLANTATIONS
FAMILY COURT
__________________________________
Complaint Number ________________
vs.
Petition Number __________________
Juvenile Number __________________
__________________________________
Reciprocal Number ________________
ORDER ACKNOWLEDGING PATERNITY
This acknowledgement of paternity was heard before Chief Judge/Associate Justice/Magistrate
______________________________________ on the _________ day of ____________, 20___, and after
hearing thereon, it is hereby
ORDERED, ADJUDGED, AND DECREED as follows:
________________________________________, who lives at _________________________________
Name of Father
Number/Street
in ________________________, ____________, born on _____________________, _____________________
City/Town
State/Country
Father’s Date of Birth
Father’s Place of Birth
□
□
□
has acknowledged paternity and the court finds by
acknowledgement,
DNA testing ,
oral or written
denial from father listed on birth record and that he is the biological father to:
First
Middle
Last
born on ___________, ______, ______ to ___________________________________________.
Month
Day
Year
Mother’s Name
THE STATE OF RHODE ISLAND DEPARTMENT OF HEALTH, DIVISION OF VITAL RECORDS
SHALL AMEND THE BIRTH CERTIFICATE OF SAID CHILD TO ADD THE FATHER’S NAME TO
THE BIRTH CERTIFICATE. THE CHILD’S NAME SHALL BE CHANGED TO:
First
Middle
Last
___________________________________________
___________________________________________
Mother’s Signature
Father’s Signature
□
□
□
□
Mother’s Whereabouts Unknown
Mother Deceased
Father’s Whereabouts Unknown
Deceased
Approved: ____________________________________
Entered: __________________________________
Chief Judge, Associate Justice
Clerk
General Magistrate, Magistrate
CERTIFICATE
_____________________________________ certifies that he shall file a Certified Copy of this Order and
pay the appropriate processing fee to the Rhode Island Department of Health, Division of Vital Records by the
_________ day of ____________________________, 20___.
_____________________________________________
_________________________
Father’s Name
Date
FURTHER INSTRUCTIONS ON THE REVERSE SIDE OF THIS FORM
FC-12 (revised August 2012)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Authorization For Release Of Protected Education Information Form - State Of Rhode Island And Providence Plantations Family Court
Legal
Application To Clerk For Entry Of Default - State Of Rhode Island And Providence Plantations District Court
Legal
Form 632 - Limited Liability Company Annual Report For The Year - Secretary Of State, State Of Rhode Island And Providence Plantations
Legal
Enhanced 9-1-1 Uniform Emergency Telephone System Report Of 9-1-1 Surcharge Revenue Form - State Of Rhode Island And Providence Plantations
Legal
Form 101 - Business Corporation Articles Of Amendment To The Articles Of Incorporation - State Of Rhode Island And Providence Plantations
Legal
Authorization For Direct Deposit - The State Of Rhode Island And Providence Plantations - Department Of Human Services Office Of Child Support Services Form
Legal
Related Categories
Parent category: Legal