Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: ATLAS Number: Lawyer's Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR FOR CLERK'S USE ONLY Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY (2) Person Filing (Petitioner) (3) Case No. (4) ATLAS No. Other Parent (Respondent) VOLUNTARY ACKNOWLEDGMENT OF PATERNITY with Affidavit of Legally Presumed Father A.R.S. § 25-814 (5) The Clerk is requested to issue an order establishing paternity for the following minor children: (List names as on birth certificates, if any.) NAME(S): First Middle (new) Last (a) (b) (c) who were born on this date and at this location (below): (List in same order as above.) Month / Day / Year (a) (b) (c) City, State, Nation of Birth (6) Mother's Full Name Maiden Name Date of Birth © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 1 of 4 DRVPM11f - 050115 American LegalNet, Inc. www.FormsWorkFlow.com Case No.________________ The mother of the children was legally married at the time of birth or at some time during the ten months prior to birth. Attached is an affidavit by the mother's husband at that time, who is legally presumed to be the father, stating that he is not the natural, biological father of these minor children. The natural father is: (7) Father's Full Name Date of Birth Birthplace (City, State, Country) Current Address The parents request the Court to Order the Office of Vital Records to amend the birth certificate(s) to correct the name of the father. (8) We base this request on: (Mark only one) Affidavit of Acknowledgment, by which we agree and acknowledge the natural father named above. OR Genetic (DNA) Testing and Laboratory Affidavit: Attached is an affidavit from a certified laboratory indicating that the father named above has not been excluded as the natural father of the minor children and we agree to be bound by the results of the genetic test. (9) The parents request the Court to Order the Office of Vital Records to amend the birth certificate(s) to change the minor child(ren)'s name(s) TO: (List in same order as (5)). (Optional) (New Names) First Middle Last (a) (b) (c) IMPORTANT NOTICE: READ THIS BEFORE YOU SIGN: Arizona law requires that before voluntarily acknowledging paternity, you be given notice of the alternatives to, legal consequences of and the rights and responsibilities that result. 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 (DNA) testing done. After you submit this Voluntary Acknowledgement of Paternity along with the Acknowledgment of the Legally Presumed Father, the Clerk of Court or authorized personnel will issue an Order legally establishing the natural 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 required by Arizona law. The Order does not decide issues about child support, parenting time or authority for legal decision making. However the Order includes a statement of Arizona law that the parent with whom the minor child has resided for the greater part of the last six months shall have authority for legal decision making unless otherwise ordered by the Court. © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com DRVPM11f - 050115 Case No.________________ Arizona law allows either parent to rescind the acknowledgment of paternity if certain requirements are met. See § 25-812(H) of the Arizona Revised Statutes for the requirements. THIS DOCUMENT CANNOT BE FILED WITHOUT THE AFFIDAVIT OF THE LEGALLY PRESUMED FATHER. This document can be notarized OR witnessed. Witness must be at least 18 years of age and not related to either parent by blood or marriage. Sign only in presence of Witness, Deputy Clerk of Court, or Notary. (10) Signature of Mother Date (10) Signature of Actual Father Date Printed Name of Mother Date Printed Name of Actual Father Date (IF NOT NOTARIZED, WITNESSED BELOW) VOLUNTARY ACKNOWLEDGMENT OF PATERNITY WITH AFFIDAVIT OF LEGALLY PRESUMED FATHER (Not required if notarized or verified by a Clerk of the Superior Court on preceding page.) Signature of Witness Signature of Witness Printed name of Witness Printed name of Witness Address of Witness Address of Witness City, State, Zip Code City, State, Zip Code STATE OF COUNTY OF STATE OF COUNTY OF This instrument was acknowledged before me this: (date) By . This instrument was acknowledged before me this: (date) By . Deputy Clerk or Notary Public (notary seal) Deputy Clerk or Notary Public (notary seal) American LegalNet, Inc. www.FormsWorkFlow.com © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 3 of 4 DRVPM11f - 050115 Case No.________________ AFFIDAVIT OF LEGALLY PRESUMED FATHER A.R.S. § 25-814(A)(1) (11) I, (printed name of legally presumed father as it appears on minor children's birth certificates) , was legally married to the mother of the minor child(ren) named on the "Voluntary Acknowledgment of Paternity" when the minor child(ren) was (were) born or at some time during the ten months prior to birth. Although according to law I am legally presumed to be the father of those minor children, I am not the natural father, and I consent to the establishment of paternity in accordance with this "Voluntary Acknowledgment of Paternity". Signing and filing this affidavit will permanently affect your legal rights and responsibilities relating to the children named in the Voluntary Acknowledgment of Paternity. You may want to consult a lawyer before signing this document. Do not sign this form until you are before a Clerk of the Court or a Notary Public. UNDER OATH OR BY AFFIRMATION I swear or affirm under penalty of perjury that the contents of this document are true and correct to the best of my knowledge and belief. Signature of Legally Presumed Father Date Printed Name of Legally Presumed Father STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) . by (notary seal) Deputy Clerk or Notary Public © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com DRVPM11f - 050115
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