The Arizona Paternity Form, officially known as the Acknowledgment of Paternity (CS-127), serves to legally establish the fatherhood of a child born outside of marriage. This form is essential for parents who wish to confirm paternity and ensure that their child has legal rights to both parents. If you are ready to proceed, fill out the form by clicking the button below.
The Arizona Paternity form, officially known as the Acknowledgment of Paternity (CS-127), serves a crucial role for parents of children born out of wedlock. This form allows both parents to legally acknowledge paternity, establishing the father’s rights and responsibilities toward the child. It is important to note that this form is not applicable if the mother was married at the time of the child’s birth or during the ten months prior, unless accompanied by a Waiver of Paternity Affidavit. Completing the form requires careful attention to detail; all information must be filled out in black ink, and corrections are not permitted. Each parent must sign in the presence of a witness or notary public, ensuring that proper identification is shown. The form also highlights the benefits of signing, such as providing the child with legal parents, financial support, and access to medical histories. Understanding the implications of this acknowledgment is essential, as it solidifies legal paternity and can affect issues related to custody and visitation. Parents should also be aware that they have the right to rescind the acknowledgment within 60 days if needed. Overall, the Arizona Paternity form is a vital document that not only affirms the relationship between a child and their father but also safeguards the child’s rights and future opportunities.
CS-127 (11-17)
GO TO FORM
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Division of Child Support Services
ACKNOWLEDGMENT OF PATERNITY
En Español
READ ALL INSTRUCTIONS CAREFULLY AND REMOVE THIS PAGE BEFORE COMPLETION
The purpose of this form is to acknowledge paternity for a child born out of wedlock.
This Acknowledgment of Paternity IS NOT applicable if the mother of the child was married at the time of birth or was married at any time in the ten months immediately preceding such birth pursuant to A.R.S. § 25-814, unless accompanied by a Waiver of Paternity Affidavit.
COMPLETION
•Read the “Acknowledgment of Paternity” (CS-127) and the Notice of Alternatives, The legal Consequences and the Rights and Responsibilities.
•Only use BLACK INK. Colored inks ARE NOT ACCEPTABLE. Type or print all required information except where sig- natures are required. The Spanish translation on the last page is for reference only. Please complete the English side.
•DO NOT MAKE CORRECTIONS ON THE FORM. Forms with crossouts, erasures, alterations, etc., will invalidate the Acknowledgment. DO NOT SUBMIT AN ACKNOWLEDGMENT CONTAINING SUCH CHANGES. If you make a mistake, ask for a new form and begin again.
•Fill in every blank or box on the form. Incomplete or incorrect information may cause delays in the filing of the
Acknowledgment.
•In cases of multiple births, a separate Acknowledgment for each child must be completed.
•The Acknowledgment must be signed in the presence of a Witness or Notary Public. Each parent must sign their name on all copies of the form and each signature must be witnessed or notarized. Each parent must show the
Witness or Notary appropriate, valid identification. The parents should use their legal name only. Nicknames, short- ened name, etc., SHOULD NOT be used. Your Legal Name is the one that appears on your birth certificate, or other official documents.
•If both parents cannot sign the Acknowledgment at the same time, use a separate Acknowledgment. When signing separate Acknowledgments the child’s information should be identical on each form. All blanks must be completed and both Acknowledgments submitted together.
•If you are changing the child’s name, after 3 months of age only the last name of the child can be changed using this form. Any other changes must be requested through the Office of Vital Records.
•If completing this Acknowledgment away from the hospital, remember to sign in the presence of a Notary Public or qualified Witness. A qualified Witness must be at least 18 years old and not related to either parent by blood or marriage. Notary Publics are listed in the telephone directory. RETURN ALL PAGES (excluding completion instruc- tions) OF THE ACKNOWLEDGMENT. Mail the entire document to:
DCSS Hospital Paternity Program – HPP
PO BOX 64533
Phoenix, AZ 85082
•If you require a copy of the birth certificate, mail your application monies, along with the birth certificate application, to the address listed on the birth certificate application. DO NOT mail any monies to the Hospital Paternity Program.
DEFINITIONS
DES - Department of Economic Security
DHS - Department of Health Services
DCSS - Division of Child Support Services
HOW WILL YOUR CHILD BENEFIT IF YOU SIGN THIS FORM?
•Every child has the right to know his or her mother and father and benefit from a relationship with both parents.
•Your child will have two legal parents.
•Your child has a right to financial support from both parents.
•It will be easier for your child to learn the medical histories of both parents and to benefit from health care coverage available to you.
•It will be easier for your child to inherit through you and receive benefits such as dependent or survivor’s benefits from Veterans Affairs or the Social Security Administration
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, dis- ability, genetics and retaliation. To request this document in alternative format or for further information about this policy, contact 602-252-4045; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request. Ayuda gratuita con traducciones relacionadas con los servicios del DES esta disponible a solicitud del cliente.
CS-127 (11-17) Page 2
NO.
Clear the Form
Formulario en Español
PLEASE
PRINT CLEARLY. Complete in BLACK INK. DO NOT ALTER, LEGAL DOCUMENT
CHILD’S INFORMATION
CHILD’S NAME (First, Middle, Last, Suffix) AS IT APPEARS ON THE BIRTH CERTIFICATE
BIRTHDATE (MM/DD/YY)
MALE
FEMALE PLACE OF BIRTH
CITY
COUNTY
STATE
HOSPITAL
HOW YOU WANT THE CHILD’S NAME TO APPEAR ON THE BIRTH CERTIFICATE
IF THE CHILD’S NAME HAS NOT CHANGED, PLEASE PRINT THE CHILD’S NAME AS IT APPEARS ON THE ORIGINAL BIRTH CERTIFICATE
FIRST
MIDDLE
LAST
SUFFIX (Jr., II)
MOTHER’S INFORMATION
FIRST NAME
MIDDLE NAME
LAST NAME
MAIDEN NAME
BIRTHDATE (MM/DD/YYYY)
SOC. SEC. NO.
AREA CODE AND PHONE NO.
PLACE OF BIRTH (City, State)
COUNTRY OF BIRTH
ADDRESS: (Street, Apt. No., City, State, ZIP)
EMPLOYER
OCCUPATION
FATHER’S INFORMATION
The mother was legally married at the time of conception and/or birth of the child.
A Waiver of Paternity Affidavit completed by
A court order or decree of dissolution which rebuts paternity is attached.
the present/former husband is attached.
This Acknowledgment is being signed voluntarily with no threat or harm or duress. I have received written and oral notice and have read the NOTICE OF ALTERNATIVES, THE LEGAL CONSEQUENCES AND RIGHTS AND RESPONSIBILITIES. I understand my alternatives, the legal consequences and the rights and responsibilities. I swear and affirm under penalty of perjury pursuant to A.R.S. §13-2702 that this application and any accompanying documents have been examined by me and to the best of my knowledge and belief are true and correct.
SIGNATURE OF MOTHER (Sign only in presence of Witness)
DATE (MM/DD/YY
SIGNATURE OF FATHER (Sign only in presence of Witness)
DATE (MM/DD/YY)
SIGNATURE OF WITNESS (TO BE COMPLETED BY THE [Check one]:
GOVERNMENT AGENCY
OTHER)
WITNESS MUST BE AT LEAST 18 YEARS OF AGE AND NOT RELATED BY BLOOD OR MARRIAGE.
PRINTED NAME OF WITNESS
ADDRESS
-------------------------------------------------------------------
NOTARY SECTION ------------------------------------------------------------------
TO BE COMPLETED BY A NOTARY PUBLIC ONLY IF NOT WITNESSED ABOVE
State of Arizona, County of
Subscribed and sworn or affirmed before me
this
day of
,
NOTARY PUBLIC
PLACE NOTARY SEAL HERE
My Commission expires
Check this box if form completed at the hospital.
Paternity Date
ALL COPIES OF THIS DOCUMENT MUST HAVE ORIGINAL SIGNATURES
*B*
For Office Use Only
THIS ACKNOWLEDGMENT IS BEING SIGNED VOLUNTARILY WITH NO THREAT OR HARM OR DURESS
CS-127 (11-17) Page 3
NOTICE OF ALTERNATIVES, THE LEGAL CONSEQUENCES
AND RIGHTS AND RESPONSIBILITIES
PLEASE READ THIS INFORMATION CAREFULLY BEFORE YOU SIGN THE FORM The purpose of this form is to acknowledge paternity for a child born out of wedlock.
We, the natural mother and natural father, declare that the information provided is true and correct. We acknowledge that the father named is the only possible father of the child named.
If the mother was married at any time in the ten months immediately preceding the birth or the child is born within ten months after the marriage is terminated by death, annulment, declaration of invalidity or dissolution of marriage or after the court enters a decree of legal separation, a Waiver of Paternity Affidavit must accompany this document pursuant to A.R.S. § 25-814.
I understand that if the current/former husband’s location is unknown to the mother, the mother will be required to apply for IV-D Services and The Division of Child Support Services will attempt to locate the current/former husband.
I understand that by signing this acknowledgment we are giving up our right to a court hearing to determine paternity as well as the right to have genetic testing done to determine the parentage of this child.
I further understand we may have a right to rescind or challenge this acknowledgment as outlined in A.R.S. § 25-812. I understand the signing of this acknowledgment will result in the legal determination of paternity.
I understand that upon the determination of paternity, both parents have a legal obligation to support their child pursuant to A.R.S. § 25-501 as well as other duties imposed by Arizona law.
I understand this paternity determination is not a custody order but provides a basis for determining issues related to cus- tody and visitation and affords the parents all rights and responsibilities provided by Arizona law.
I understand that either parent has a right to cancel the Acknowledgment of Paternity by completing an Affidavit of Paterni- ty Rescission within 60 days from the date of the last witnessed/notarized signature on the Acknowledgment and sending it to the Hospital Paternity Program pursuant to A.R.S. § 25-812. I have read the information provided and received oral notification of our rights and responsibilities by either speaking to staff, viewing a paternity video or phoning 1-800-485- 6908.
A voluntary Acknowledgment of Paternity filed with The Department of Economic Security or The Department of Health Services has the same force and effect as a Superior Court judgment pursuant to A.R.S. § 25-812.
I further declare this statement to be made for recording with the Clerk of the Superior Court, the Department of Economic Security or the Department of Health Services pursuant to A.R.S. § 25-812 and hereby consent and request that the birth certificate be amended to show the father’s name and to show the child’s name as requested on the front of the Acknowl- edgment of Paternity. Please note: Any questions regarding name changes should be directed to the Arizona Department of Health Services, Office of Vital Records at (602) 364-1300.
I understand that if it is deemed appropriate by DES, this acknowledgment may be used to obtain a paternity order in any Arizona county having venue.
I understand that I am required to provide my Social Security Number pursuant to 42 USC § 652(a)(7) and 666(a)(5)(IV). DES/DCSS will use this information to establish paternity and if appropriate, to establish and enforce a child support order. I swear or affirm under penalty of perjury pursuant to A.R.S. § 13-2702 that this application and/or accompanying docu- ments have been examined by me and to the best of my knowledge and belief are true and correct.
WHAT DOES IT MEAN IF YOU SIGN THIS FORM?
By signing this Acknowledgment of Paternity you are legally establishing your child’s paternity. Paternity means legal fatherhood.
Signing this form is voluntary. You should not sign this form if you have been threatened or coerced.
This Acknowledgment does not automatically give the father visitation or custody rights, but he may use it to ask the Court for them.
Either parent can rescind this form within 60 days of the last signature on the form by signing an Affidavit of Paternity Re- scission (CS-258). To request an Affidavit of Paternity Rescission, contact the Hospital Paternity Program at 1-800-485-6908.
CS-127 (11-17) Page 4
Office of Vital Records
ADDITIONAL INFORMATION REGARDING THE FATHER LISTED ON
THE ACKNOWLEDGMENT OF PATERNITY (for birth certificate processing purposes)
The Arizona Department of Health Services’ Office of Vital Records is required to collect and report data to the Department of Health and Human Services’ National Center for Health Statistics (NCHS). Please complete the data below in order to capture this information for statistical purposes. Thank you in advance for completing this information.
CHILD’S NAME (First, Middle, Last, Suffix)
BIRTHDATE
MOTHER’S NAME (Last, First, M.I.)
FATHER’S NAME (Last, First, M.I.)
FATHER’S EDUCATION (Check One)
What is the highest level of schooling you will have completed at the time of the child’s delivery? Check one of the following boxes that best describes your education. If you are currently enrolled, check the box that indicates the previous grade or highest degree received.
8th grade or less
Associate degree (e.g. AA, AS )
9th – 12th grade, no diploma
Bachelor’s degree (e.g. BA, AB, BS )
High school graduate or GED completed
Master’s degree (e.g. MA, MS MEng, Med, MSW, MBA )
Some college credit, but no degree
Doctorate degree (e.g. PhD, EdD) or
Professional degree (e.g. MD, DDS, DVM, LLB, JD )
FATHER’S RACE (Check All That Apply)
White
Black, African American
American Indian or Alaska Native (*see list below) Primary or Enrolled tribe:
Additional Tribe:
Additional Tribe: Asian Indian Chinese Filipino Japanese Korean
Other Asian
Specify:
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
Other
Unknown
Refused
Not Obtainable
*Please select the appropriate Arizona tribe(s) the father is affiliated with from the list provided below and print the tribe name in the space(s) provided above. If the father is affiliated with a non-Arizona tribe, please write “other” in the space provided or print the name of the non-Arizona tribe.
Ak Chin Indian Community
Navajo Tribe
Camp Verde Yavapai Apache
Pascua Yaqui
Cocopah Tribe
Prescott Yavapai Indian Community Quechan Tribe
Colorado River Indian Tribes
Salt River Indian Community (Pima)
Fort Mohave Tribe
San Carlos Apache Tribe
Ft. McDowell Mohave-Apache Community Gila River Indian Community
San Juan Southern Paiute Band
(Pima) Havasupai Tribe
Tohono O’Odham Tribe (Papago)
Hopi Tribe
Tonto Apache
Hualapai Tribe
White Mountain Apache Tribe (Fort Apache)
Kaibab Band of Paiute Indian
FATHER’S HISPANIC ORIGIN (Check One)
No, not Spanish, Hispanic or Latino
Dominican, Columbian)
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic/Latina (e.g. Spaniard, Salvadoran,
CS-127 (11-17) Page 5
Division of Child Support Services (División de Servicio de Sustento para Menores)
RECONOCIMIENTO DE PATERNIDAD
LEA DETENIDAMENTE TODAS LAS INSTRUCCIONES Y DESPRENDA ESTA HOJA ANTES DE LLENAR EL FORMULARIO
El propósito de este formulario es reconocer paternidad para un niño nacido a una madre soltera. Conforme a A.R.S. §25-814(b), este Reconocimiento de Paternidad NO ES aplicable si la madre del niño estuvo casada cuando nació el niño o en cualquier momento durante los diez meses inmediatamente anteriores al nacimiento del niño, salvo que cuando esté acompañado por una Renuncia de Afidávit de Paternidad.
PARA LLENAR EL FORMULARIO
•Lea el “Reconocimiento de Paternidad” (CS-127) y el Aviso de Alternativos, “las Consecuencias legales” y “los Derechos y Res- ponsabilidades’
•Use sólo TINTA NEGRA. NO SE ACEPTARÁ tintas en colores. Escriba a máquina o con letra de molde toda la información reque- rida excepto donde haya que firmar. La traducción al español en la última página es sólo para referencia; sírvase llenar el lado en inglés.
•NO HAGA CORRECCIONES EN EL FORMULARIO. Formularios con tachones, borraduras, alteraciones etc. invalidarán el Reco- nocimiento. NO PRESENTE UN RECONOCIMIENTO QUE CONTENGA TALES MODIFICACIONES. Si comete un error, pida otro formulario y empiece de nuevo.
•Llene cada uno de los espacios o cajas del formulario. La información incompleta o incorrecta puede causar demoras en el registro del Reconocimiento.
•En casos de nacimientos múltiples hay que llenar un Reconocimiento individual para cada niño.
•El reconocimiento se habrá de firmar ante un testigo o notario público. La madre y el padre tienen que firmar sus nombres en todas las copias del formulario y cada una de las firmas tiene que ser certificadas ante un testigo o notario público. La madre y el padre tienen que mostrar identificación apropiada y válida al testigo o notario. Ambos padres deberán utilizar solamente sus nombres legales. NO SE PODRÁ utilizar apodos, nombres acortados, etc. Su nombre legal es el que aparece en su certificado de nacimiento u otros documentos oficiales.
•Si ambos padres no pueden firmar el Reconocimiento a la vez, use Reconocimientos separados. Cuando firmen Reconocimientos separados, la información sobre el niño tiene que ser idéntica en ambos formularios. Todos los espacios se tienen que llenar, y presentarse ambos Reconocimientos simultáneamente.
•Si usted va a cambiar el nombre del niño, después de los 3 meses de edad se puede cambiar solamente el apellido del niño usando este formulario. Se debe pedir cualquier otro cambio por la oficina de estadísticas demográficas
•Si llenan este Reconocimiento fuera del hospital, recuerde certificar las firmas ante un notario público o un testigo calificado. Un testigo calificado tiene que tener por lo menos 18 años de edad y no tener parentesco sanguíneo o por matrimonio con ninguno de los padres. Los notarios públicos están listados en el directorio telefónico. DEVUELVA TODAS LAS PÁGINAS DEL RECONOCI- MIENTO (excepto las instrucciones para llenarlo). Envíe el documento completo a:
•Si requiere una copia del certificado de nacimiento, envíe su dinero de solicitud, también con la solicitud por certificado de naci- miento, a la dirección listada en la solicitud por certificado de nacimiento. NO envíe ningún dinero al Programa de Paternidad en los Hospitales.
DEFINICIONES
DES - Departamento de Seguridad Económica
DHS - Departamento de Servicios de Salud
DCSS - División de Servicio de Sustento para Menores
¿CÓMO SE APROVECHARÁ SU HIJO SI USTED FIRME ESTE FORMULARIO?
•Cada niño tiene derecho de conocer a su madre y padre y sacar provecho de una relación con ambos padres.
•Su hijo tendrá tanto una madre como un padre legal.
•Su hijo tiene derecho de asistencia financiera de ambos padres.
•Será más fácil para su hijo obtener las historias médicas de ambos padres y aprovecharse la cobertura médica disponible a usted.
•Será más fácil para su hijo heredar a través de usted y recibir beneficios tales como beneficios para dependientes o sobrevivientes de la Administración de Veteranos o la Administración de Seguro Social.
Programa y Empleador con Igualdad de Oportunidades • Bajo los Títulos VI y VII de la Ley de los Derechos Civiles de 1964 (Títulos VI y VII) y la Ley de Estadounidenses con Discapacidades de 1990 (ADA por sus siglas en inglés), Sección 504 de la Ley de Rehabilita- ción de 1973, Ley contra la Discriminación por Edad de 1975 y el Título II de la Ley contra la Discriminación por Información Genética (GINA por sus siglas en inglés) de 2008; el Departamento prohíbe la discriminación en la admisión, programas, servicios, actividades o empleo basado en raza, color, religión, sexo, origen, edad, discapacidad, genética y represalias. Para obtener este documento en otro formato u obtener información adicional sobre esta política, llame al 602-252-4045; Servicios de TTY/TDD: 7-1-1. • Ayuda gratuita con traducciones relacionadas a los servicios del DES está disponible a solicitud del cliente. Free language assistance for DES services is available upon request
CS-127 (11-17) Page 6
Form in English
NÚM. Remueva el Formulario
FAVOR DE ESCRIBIR CLARAMENTE. Llene con TINTA NEGRA. NO ALTERE ESTE DOCUMENTO LEGAL
INFORMACIÓN DEL NIÑO
NOMBRE DEL NIÑO (Primer nombre, segundo, apellido, sufijo) COMO APARECE EN EL CERTIFICADO DE NACIMIENTO
FECHA DE NACIMIENTO (Mes/día/año)
FEMALE LUGAR DE NACIMIENTO CIUDAD
CONDADO
ESTADO
CÓMO DESEA QUE APAREZCA EL NOMBRE DEL NIÑO EN EL CERTIFICADO DE NACIMIENTO
SI EL NOMBRE DEL NIÑO NO HA CAMBIADO, ESCRIBA EL NOMBRE TAL COMO APARECE EN EL CERTIFICADO DE NACIMIENTO ORIGINAL
PRIMER NOMBRE
SEGUNDO NOMBRE
APELLIDO
SUFIJO (Jr., II)
INFORMACIÓN DE LA MADRE
NOMBRE DE SOLTERA
NÚM. DE SEGURO SOCIAL
CÓDIGO DE ÁREA Y TELÉFONO
LUGAR DE NACIMIENTO (Ciudad, estado)
PAÍS DE NACIMIENTO
DOMICILIO (Calle, núm. de apartamento, ciudad, estado, código postal ZIP)
EMPLEADOR
OCUPACIÓN
INFORMACIÓN DEL PADRE
La madre estaba casada legalmente al momento de la concepción/el nacimiento del niño. Adjunto hay una orden del tribunal o decreto de disolución que refuta la paternidad.
Adjunto hay una renuncia de Affidávit de Paternidad llenado por del esposo actual/anterior.
Este Reconocimiento de Paternidad se firma voluntariamente, sin amenaza, ni perjuicio ni por coacción. He recibido aviso escrito y verbal, y he leído el AVISO DE LAS OPCIONES, LAS CONSECUENCIAS LEGALES Y LOS DERECHOS Y RESPONSABILIDADES. Comprendo mis opciones, las consecuencias legales y los derechos y las responsabilidades. Juro y afirmo bajo pena de perjurio conforme a A. .S. §13-2702 que he examinado esta solicitud y todos los documentos adjuntos y que según mi leal entender y saber, son ciertos y correctos.
FIRMA DE LA MADRE
FECHA (Mes/día/año)
FIRMA DEL PADRE
(Firma solamente en presencia de un Testigo)
NO FIRME AQUÍ
FIRMA DEL TESTIGO (SERÁ LLENADO POR [Marque uno] :
GUBERNAMENTAL
OTRO)
AGENCIA GUBERNAMENTAL
AGENCIAINVALIDO PARA REGISTRO
EL TESTIGO HABRÁ DE TENER POR LO MENOS 18 AÑOS DE EDAD Y NO TENER PARENTESCO SANGUÍNEO NI POR MATRIMONIO.
NOMBRE DEL TESTIGO CON LETRA DE MOLDE
DIRECCIÓN
-----------------------------------------------------------
SECCIÓN PARA EL NOTARIO ----------------------------------------------------------
LA LLENARÁ UN NOTARIO PÚBLICO SOLAMENTE EN AUSENCIA DE TESTIGOS ARRIBA
Estado de Arizona, condado
Subscrito y jurado o afirmado ante mí
este
día de
NOTARIO PÚBLICO
SELLO DEL NOTARIO AQUÍ
Mi comisión termina
Marque esta cajita se llenó el formulario en el hospital.
Fecha de paternidad
TODAS LAS COPIAS DE ESTE DOCUMENTO DEBEN TENER FIRMAS ORIGINALES.
Sólo para uso de oficina
ESTE DOCUMENTO DE PATERNIDAD SE FIRMA VOLUNTARIAMENTE, SIN AMENAZA, PERJUICION NI COACCIÓN
CS-127 (11-17) Page 7
AVISO DE LAS OPCIONES, LAS CONSECUENCIAS LEGALES,
LOS DERECHOS Y LAS RESPONSABILIDADES
LEA ESTA INFORMACIÓN DETENIDAMENTE ANTES DE FIRMAR EL FORMULARIO
El propósito de este formulario es reconocer paternidad para un niño nacido a una madre soltera.
Nosotros, la madre biológica y el padre biológico, declaramos que la información provista es cierta y correcta. Reconoce- mos que el padre nombrado es el único padre posible del niño nombrado.
Si la madre del niño estuvo casada en cualquier momento durante los 10 meses inmediatamente anteriores al nacimiento del niño o si el nacimiento del niño ocurrió dentro de 10 meses de haber terminado el matrimonio por causa de muerte, anulación, declaración de invalidez o disolución del matrimonio, o después que el tribunal haya registrado un decreto de separación legal. Según A.R.S. § 25-814, una Renuncia de Affidávit de Paternidad debe acompañar este documento.
Entiendo que si la madre no sabe el paradero del esposo actual/anterior, la madre tendrá que solicitar servicios de IV-D y la División de Servicio de Sustento para Menores intentará localizar al esposo actual/anterior.
Entiendo que al firmar este reconocimiento cedemos nuestro derecho de una audiencia para determinar paternidad ante un tribunal, así como nuestro derecho de pruebas genéticas para determinar la paternidad para este niño.
Entiendo además que quizá tengamos derecho de rescindir o recusar este reconocimiento conforme a A.R.S. § 25-812. Entiendo que el firmar este reconocimiento resultará en la determinación legal de la paternidad.
Entiendo que al determinar la paternidad, ambos padres tienen una obligación legal de mantener a su hijo conforme a A.R.S. § 25-501, así como otras obligaciones impuestas por la ley de Arizona.
Entiendo que esta determinación de paternidad no es una orden de custodia pero sirve como base para determinar asuntos relacionados con la custodia y las visitas, y proporciona a los padres todos los derechos y responsabilidades provistos por la ley de Arizona.
Entiendo que cualquiera de los padres tiene derecho de cancelar el Reconocimiento de Paternidad llenando un Afidávit de Rescisión de Paternidad dentro de 60 días desde la fecha de la última firma preparada ante un testigo/notario público en el Reconocimiento, y enviándolo al Programa de Paternidad en Hospitales conforme a A.R.S. § 25-812. He leído la informa- ción provista y recibido aviso verbal de nuestros derechos y responsabilidades bien por hablar con el personal, o por ver un video sobre la paternidad, o por llamar aI 1-800-485-6908.
Un Reconocimiento de Paternidad voluntario registrado con el Departamento de Seguridad Económica o el Depar- tamento de Servicios de Salud tiene el mismo peso y efecto como un fallo del Tribunal Superior conforme a A.R.S. § 25-812.
Declaro además que esta declaración sea hecha para ser registrada con el Secretario del Tribunal Superior, el Departa- mento de Seguridad Económica o el Departamento de Servicios de Salud conforme a A.R.S. § 25-812, y por este acto con- siento y pido que se enmiende el certificado de nacimiento para reflejar el nombre del padre y el nombre del niño tal como sea pedido en el frente del Reconocimiento de Paternidad. Note por favor: Cualquier pregunta relacionada con cambiar el nombre se deberá dirigir al Departamento de Servicios de Salud, Oficina de Estadísticas Demográficas.
Entiendo que si DES lo estima apropiado, este reconocimiento se podrá utilizar para obtener una orden de paternidad en cualquier condado con jurisdicción en Arizona.
Entiendo que conforme a 42 USC § 652(a) (7) y 666(a) (5) (IV) debo proporcionar mi número de Seguro Social. DES/ DCSS utilizará esta información para establecer paternidad y, si es apropiado, para establecer y hacer cumplir una orden de alimentos para menores.
Juro o afirmo bajo pena de perjurio conforme a A.R.S. § 13-2702 que he examinado esta solicitud y/o los documentos ad- juntos y que según mi mejor saber y entender son ciertos y correctos.
¿QUÉ SIGNIFICA SI YO FIRME ESTE FORMULARIO?
Mediante su firma en este Reconocimiento de Paternidad usted legalmente establece la paternidad de su niño. La pater- nidad significa que usted es el padre legal del niño.
El firmar este formulario es voluntario. Usted no debe firmar este formulario si le han amenazado o coaccionado.
Este Reconocimiento no le otorga automáticamente al padre los derechos de custodia o visitas, pero él puede utilizarlo para pedir esos derechos en el tribunal.
Cualquiera de los padres puede rescindir este formulario dentro de 60 días de la última firma en el formulario firmando un Afidávit de Rescisión de Paternidad (CS-258). Comuníquese con el Programa de Paternidad en Hospitales al 1-800-485- 6908 si desea un Afidávit de Rescisión de Paternidad.
CS-127 (11-17) Page 8
(Departamento de Sanidad de Arizona)
Office of Vital Records (Oficina de Registro Civil)
INFORMACIÓN ADICIONAL SOBRE EL PADRE QUE FIGURA EN EL
RECONOCIMIENTO DE PATERNIDAD (para el trámite de partida de nacimiento)
La Oficina de Registro Civil del Departamento de Sanidad de Arizona tiene la obligación de recabar y transmitir la información al Centro Nacional de Estadísticas de Sanidad del Departamento de Sanidad y Servicios Humanitarios (NCHS por sus siglas en inglés). Por favor proporcione los datos que se solicitan a continuación, los que se recaban con fines estadísticos. Gracias de antemano por proporcionar la información.
NOMBRE DEL NIÑO (apellido, nombre, sufijo)
FECHA DE NACIMIENTO
NOMBRE DE LA MADRE
NOMBRE DEL PADRE
(apellido, nombre, inicial del segundo nombre)
EDUCACIÓN DEL PADRE (marque una)
¿Cuál es el nivel más alto de educación que usted obtuvo al momento del nacimiento del niño? Marque una de las casillas que mejor des- criba su educación. Si en la actualidad usted está matriculado, marque la casilla que indica el grado anterior o el título más alto obtenido.
8.ᵃᵛᵒ grado o menos
Diploma por dos años de estudios superiores (ej. AA, AS)
9.ᶰᵒ – 12.ᵃᵛᵒ grado, no diploma
Licenciatura (ej. BA, AB, BS )
Graduado de bachillerato o certificado de GED
Maestría (ej. MA, MS MEng, Med, MSW, MBA)
Algunos créditos de educación superior, pero sin título
Doctorado (ej. PhD, EdD) o Profesional (ej. MD, DDS, DVM, LLB, JD)
RAZA DEL PADRE (marque todo lo que corresponda)
Blanco
Negro, afroestadounidense
Amerindio o nativo de Alaska (*vea la lista a continuación) Tribu principal o inscrita:
Tribu adicional: Tribu adicional: Tribu adicional:
Indio asiático
Chino
Filipino
Japonés
Coreano
Otros asiáticos
Especifique:
Hawaiano
Guameño o chamorro
Samoano
Otros isleños de la Polinesia
Otros
Desconocido
Rehúsa
No se puede obtener
*Por favor, seleccione de la siguiente lista la(s) tribu(s) apropiada(s) de Arizona con la(s) que el padre tiene afiliación y escriba el nom- bre de la tribu en el espacio que se da a continuación. Si el padre tiene afiliación a una tribu que no es de Arizona, por favor escriba “otros” en el espacio correspondiente o el nombre de la tribu que no pertenece a Arizona.
Comunidad Indígena Ak Chin
Tribu Navajo
Tribu Cocopah
Comunidad Indígena Prescott Yavapai
Tribus Indígenas de Colorado River
Tribu Quechan
Tribu Fort Mohave
Comunidad Indígena Salt River (Pima)
Comunidad Mohave-Apache Ft. McDowell
Tribu San Carlos Apache
Comunidad Indígena Gila River (Pima)
Tribu Havasupai
Tribu Tohono O’Odham (Papago)
Tribu Hopi
Tribu Hualapai
Tribu White Mountain Apache (Fort Apache)
Kaibab Band de Indígenas Paiute
ORIGEN HISPÁNICO DEL PADRE (marque uno)
No, no soy español, hispánico o latino
dominicano, colombiano)
Sí, soy mejicano, mejicano americano, chicano
Sí, soy portorriqueño
Sí, soy cubano
Sí, soy otro español/hispánico/latino (ej. español, salvadoreño,
Completing the Arizona Paternity form is an important step in establishing legal fatherhood for a child born out of wedlock. Once you have filled out the form correctly, it must be signed in the presence of a witness or notary public. After submission, the acknowledgment will be processed, ensuring that the child's legal rights and parental responsibilities are recognized.
The Arizona Paternity form, known as the Acknowledgment of Paternity (CS-127), is designed to legally establish paternity for a child born out of wedlock. It is important for ensuring that the child has two legal parents, which brings various rights and responsibilities for both parents.
This form should be completed by both the mother and the father of the child if they are not married at the time of the child's birth. It is not applicable if the mother was married at the time of birth or within ten months prior unless accompanied by a Waiver of Paternity Affidavit.
In cases of multiple births, a separate Acknowledgment of Paternity must be completed for each child. Each form should contain identical information regarding the child.
If both parents cannot sign together, they should use separate Acknowledgments. It is crucial that the child’s information is consistent on both forms, and both must be submitted together.
Yes, but only the last name of the child can be changed using this form if the child is over three months old. Any other name changes must be requested through the Office of Vital Records.
Yes, either parent can rescind the Acknowledgment within 60 days of the last signature by completing an Affidavit of Paternity Rescission. This must be submitted to the Hospital Paternity Program.
Using the Wrong Ink Color: It's essential to fill out the form using only black ink. Any other color will lead to rejection of the form.
Making Corrections: If a mistake is made, do not attempt to correct it on the form. This includes crossouts or erasures, which will invalidate the acknowledgment. Instead, request a new form.
Leaving Blanks: Every section of the form must be completed. Leaving any blanks can cause delays in processing your acknowledgment.
Using Nicknames: Parents must use their legal names as they appear on official documents. Nicknames or shortened names are not acceptable.
Failing to Sign in Presence of a Witness: The acknowledgment must be signed in front of a witness or notary public. This step is crucial for the form's validity.
Not Submitting All Required Copies: Each parent must sign all copies of the form, and these should be submitted together if separate acknowledgments are used.
Not Understanding Legal Implications: Parents should fully comprehend the rights and responsibilities that come with signing the acknowledgment. It's vital to read all provided information carefully.
The Arizona Paternity form is an essential document for establishing legal fatherhood for children born out of wedlock. Along with this form, several other documents may be necessary to ensure proper processing and legal recognition of paternity. Below is a list of commonly used forms and documents related to the Arizona Paternity process.
Understanding these documents can help parents navigate the paternity process more effectively. Each form serves a specific purpose and plays a crucial role in establishing rights and responsibilities for both parents. If you have any questions about these forms or the process, seeking assistance from a legal professional is advisable.
The Arizona Acknowledgment of Paternity form is similar to the Affidavit of Paternity, which serves a similar purpose in establishing legal fatherhood for a child born out of wedlock. Like the Acknowledgment, the Affidavit must be signed by both parents and often requires a witness or notary. This document also outlines the rights and responsibilities of the parents, ensuring that the child has access to both parents for support and inheritance. Both forms aim to create a legal relationship between the father and child, but the Affidavit may have additional provisions for genetic testing or court proceedings if there is a dispute.
Another document that shares similarities is the Child Support Agreement. This agreement is often completed after paternity is established and outlines the financial responsibilities of both parents. Like the Acknowledgment of Paternity, it requires signatures from both parents and can be enforced by the court. The Child Support Agreement helps ensure that the child receives the necessary financial support from both parents, reinforcing the legal obligations that arise once paternity is acknowledged.
The Birth Certificate Application is another related document. When paternity is established, parents often need to complete this application to include the father's name on the child's birth certificate. Similar to the Acknowledgment of Paternity, this application must be filled out accurately and submitted to the appropriate state department. Both documents serve to legally recognize the father’s role and ensure that the child has access to benefits associated with having two legal parents.
The Parenting Plan is also comparable, as it outlines the custody and visitation arrangements for the child after paternity is established. While the Acknowledgment of Paternity focuses on recognizing legal fatherhood, the Parenting Plan goes further by detailing how both parents will share responsibilities and time with the child. This document is crucial for ensuring that both parents are involved in the child's life, and it can be modified as needed, just like the Acknowledgment can be rescinded within a certain timeframe.
Lastly, the Waiver of Paternity Affidavit can be seen as a counterpart to the Acknowledgment of Paternity. This document is used when a mother was married at the time of the child's birth, and it allows the husband to waive his rights to paternity. It must accompany the Acknowledgment if the mother was married, ensuring that the legal process respects the existing marriage while still recognizing the biological father. Both forms work together to clarify paternity issues and protect the rights of all parties involved.
When filling out the Arizona Paternity form, it is crucial to follow specific guidelines to ensure the process goes smoothly. Here is a list of things you should and shouldn’t do:
Following these guidelines is vital for the acknowledgment of paternity to be legally recognized. Ensure that you take the time to review your form thoroughly before submission.
Here are some common misconceptions about the Arizona Paternity form, along with clarifications to help you understand the process better.
Here are key takeaways regarding the Arizona Paternity form (CS-127):
Ensure that all instructions are followed carefully to prevent issues with the acknowledgment process.