Voluntary Request For Order Of Paternity Page 3
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4AFFIDAVIT OF ACKNOWLEDGMENT OF PATERNITY – (FORM A)
IMPORTANT NOTICE!
READ THIS BEFORE YOU SIGN:
Arizona State Law requires that before voluntarily acknowledging paternity, you be given notice of
the alternatives to, the legal consequences of, and the rights and responsibilities that result. Here
are some of the things you should know.
• No one is required to voluntarily acknowledge paternity,
• You have the right to seek legal advice before signing this document, and
• If you are unsure who the father is, an alternative is to have genetic testing done.
After you have agreed to voluntarily acknowledge paternity, the Clerk of the Court will issue an
order legally establishing the father. This order is the same as a judgment of the Superior Court.
After the order is issued, both parents will have all the rights and responsibilities of parents as
required under Arizona Law. This order does not decide issues about child support, parenting time
(visitation) or custody. However, the order includes a statement of Arizona Law that the parent
with whom the child has resided for the greater part of the last six months shall have legal custody,
unless otherwise ordered by the Court.
Arizona Law allows either parent to rescind the acknowledgment of paternity if certain
requirements are met. You may have up to sixty days to do this. See § 25-812(H) of the Arizona
Revised Statutes.
*
NOTE:
SOCIAL SECURITY NUMBER MUST BE PROVIDED. IT CAN BE OMITTED FROM THIS
DOCUMENT AS LONG AS YOU INCLUDE IT ON THE CONFIDENTIAL SENSITIVE DATA
FORM (ATTACHED).
NAME(S) OF CHILD(REN) BORN OUT OF WEDLOCK:
DATE OF BIRTH:
________________________________________________
________________________________
________________________________________________
________________________________
________________________________________________
________________________________
________________________________________________
_________________________________
NATURAL MOTHER & LEGAL CUSTODIAN OF ABOVE
*SOCIAL SECURITY NUMBER
NAMED CHILD(REN)
________________________________________________
_________________________________
NATURAL FATHER OF ABOVE NAMED CHILD(REN)
*SOCIAL SECURITY NUMBER
Both Mother and Father hereby acknowledge that __________________________________is the natural mother and
______________________________________ is the natural father of the above-named child(ren).
Page 3 of 4
11/2/2006
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