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Request For Verification Of A Michigan Affidavit Of Parentage Record - Michigan
| Request For Verification Of A Michigan Affidavit Of Parentage Record Form. This is a Michigan form and can be used in General Statewide . |
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REQUEST FOR VERIFICATION OF A MICHIGAN AFFIDAVIT OF PARENTAGE RECORD For Additional Information: (517) 335-8666 www.michigan.gov/mdch Please type or print clearly and legibly - this application will be used as a mailing insert APPLICANT (PERSON REQUESTING VERIFICATION) DATE: / / ³ ³ ³ ³ Agency Name Applicant=s Name Mailing Address City/State/Zip K APPLICANT=S SIGNATURE: = Must be signed in order to process K (Sign Here) _______________________________________________ VERIFICATION INFORMATION - A request for a verification of a Michigan Affidavit of Parentage record (filed in the Central Paternity Registry since June 1, 1997) will be returned to you stamped with an indication that a record was identified which matched the supplied facts, or that no record could be identified which matched the supplied facts. This information must match exactly what is on the record. No additional information can be supplied by the Vital Records Office. State law requires a $10.00 fee for each search of the facts for verification. FACTS TO BE VERIFIED Names on the Record (Must match exactly what is on record) METHOD OF PAYMENT - Payment must be made in U.S. funds by check or money order payable to the AState of Michigan@ @ Each Verification Search (Non-Refundable) $ $ 10.00 10.00 _____________________________________________ (Child) First Middle Last * EXPEDITED SEARCH (Non-Refundable) (In addition to the regular search fee) TOTAL ENCLOSED _____________________________________________ (Mother) First Middle Last $ _____________________________________________ (Father) First Middle Last We cannot process your request without payment. When mailing, please remember to include check or money order. IF REGULAR SEARCH: VITAL RECORDS REQUESTS P.O. Box 30721 Lansing MI 48909 Child=s Date of Birth (Must match exact date on record) = __________________________________________________ Month Day Year IF EXPEDITED SEARCH: VITAL RECORDS RUSH PO Box 30721 Lansing MI 48909 TURN-AROUND TIME - For regular or expedited mail requests, please allow additional time for mailing and our department=s receipting of your payment. REGULAR SEARCH - Processing time will be 4 weeks for mail or counter requests. EXPEDITED SEARCH - If you pay the expedited search fee (in addition to the regular search fee), a mail request will be processed in 2 weeks and a counter request will be processed in 1-3 hours . DCH-0569-VERAOP Rev 3/9/06 By Authority of MCL 333.2881(2) and 333.2891(4)(f) If you wish to have the results of the verification faxed to you, please indicate the fax number here: ( ) ___________________________ VERIFICATION STAMP (for Vital Records Official Stamp) American LegalNet, Inc. www.FormsWorkflow.com
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