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Acknowledgment Of Paternity - Oklahoma
| Acknowledgment Of Paternity Form. This is a Oklahoma form and can be used in Child Support District Court Statewide . |
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*03PA209E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES Acknowledgment of Paternity This legal document establishes paternity under Oklahoma law. Do not sign unless you understand your rights and responsibilities as explained on the back of this form. Type or print in ink by pressing hard. No cross outs, correction fluid, or alterations allowed. Child's information as it now appears on birth certificate I. Child's name Date of birth First Middle Last County State Last State Enrolled? Sex, check one Male Female Tribal affiliation, if any Maiden name Zip code Yes No Social Security number Name of hospital or entity completing form Facility code number Place of birth City First Middle City Yes No No Last name of child should now be Social Security number II. Mother's name Current address American Indian? Date of birth Telephone number What tribe(s)? Was mother married at time of Yes conception or birth? III. Father's name First If yes, husband's name Middle Last Suffix If yes, husband/former husband must complete Form 03PA210E, Denial of Paternity, and attach it to this Form 03PA209E. Date of birth Social Security number Have you taken a genetic test to determine paternity of this child? Check one. Yes No Yes No If yes, did the test result show that you are the father of this child? Check one. If the genetic test showed you are not the biological father, STOP, DO NOT SIGN THIS ACKNOWLEDGMENT! Current address Place of birth City County State City State Zip code Yes Yes Address Address No No Telephone number What tribe(s)? American Indian? Enrolled? IV. Employment information Father's employer Mother's employer V. Private insurance information Father's carrier Policy number For this birth, insurance coverage began VI. 1. 2. 3. 4. 5. Mother's carrier Insured's relationship to child Policy number Policy type By signing below, I declare under penalty of perjury that I have read and understand this Acknowledgment of Paternity. I declare the information in this Acknowledgment is true and: I have been given written and oral notice of my legal rights and responsibilities. The child whose paternity is being acknowledged does not have a presumed father, or has a presumed father whose full name is stated above, and does not have another acknowledged or adjudicated father. The father named in this acknowledgment is the natural father of this child. I understand this acknowledgment is the equivalent of a judicial adjudication of paternity and that a challenge to the acknowledgment is permitted only under limited circumstances and is barred after two years. By signing this Acknowledgment of Paternity, I give up my right to establish paternity by genetic testing at a later time. Date signed Printed name X Father's signature X Witness's signature Address of witness Witnesses cannot be related to mother or father. Date signed Printed name X Mother's signature X Witness's signature Address of witness Parents cannot witness each other's signatures. You have the right to withdraw your acknowledgment within 60 days after the effective date of the acknowledgment, or if you are under age 18 when you sign, you have 60 days after turning age 18. You must file a signed Form 03PA211E, Rescission of Acknowledgment of Paternity, with the Oklahoma State Department of Health (OSDH), Division of Vital Records. To obtain Form 03PA211E, call 405-522-2273 in the Oklahoma City calling area, 918-295-3500 in the Tulsa calling area, 1-800-522-2922 toll free, or contact your closest child support office or OSDH Division of Vital Records. Distribution of copies: white to OSDH Division of Vital Records, yellow to OKDHS Child Support Enforcement Division, pink to Mother, gold to Father. OKDHS issued 11-1-2006 03PA209E (CSED-209) American LegalNet, Inc. www.FormsWorkflow.com 03PA209E (CSED-209) Acknowledgment of Paternity Acknowledgment of Paternity Rights and Responsibilities Please read all information and instructions before signing this Acknowledgment of Paternity. Use this form to establish paternity for a child born to parents who were not married to each other when the child was conceived or born. The biological father of the child named on the acknowledgment will have his name added to the child's birth certificate and the child's last name can be changed. By signing this Acknowledgment of Paternity to establish legal fatherhood, you give up your right to establish paternity later by genetic testing. The signers of this acknowledgment undertake the legal responsibility to support the child. If the child lives with someone other than both parents, the parents may have to pay child support. To safeguard everyone's legal rights in this process, please consider all of the information below. The only man who should sign this acknowledgment is the biological father of this child. Do not sign this acknowledgment if you are not sure you are the biological father. You may sign the form later, as there is no time limit on establishing paternity if there is no father listed on the birth certificate. If you sign the form after the child's 18th birthday, the child must sign Form 03PA212E, Adult Child's (18 Years or Older) Consent Form. The adult child states on the form that he or she agrees to the addition of the father's name to his or her birth certificate. Need help in deciding who is the biological father? You may obtain private genetic testing to determine paternity or receive those services with no up-front cost by opening a case with the Oklahoma Department of Human Services, Child Support Enforcement Division (CSED). If you have any questions about this form or CSED services, please contact CSED at 405-522-2273 in the Oklahoma City calling area, 918-295-3500 in the Tulsa calling area, or toll free at 1-800-522-2922. By signing this Acknowledgment of Paternity you verify receiving oral notice of your rights and responsibilities. Please call your local number above to listen to the presentation and follow these steps: · · · · At the first voice prompt, select either 1 for English or 2 for Spanish. At the second voice prompt, select 2 for "All other callers." At the third voice prompt, select 4 for "Information on establishing paternity." At the fourth voice prompt, select 2 to "Hear the Notice of Rights and Responsibilities of Paternity." When the mother was married to someone other than the man signing this form at the time of conception or birth another step is required. Her husband must fill out and sign Form 03PA210E, De
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