(1) Person Filing: Street Address: City, State, Zip Code: Phone Number: Representing Self SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO (2) Petitioner: [ ] Mother [ ] Father Maiden Name: Social Security Number: Birthdate: Birthplace (City, State, Country): Case Number: DO ORDER OF PATERNITY (3) Respondent: [ ] Mother [ ] Father Maiden Name: Social Security Number: Birthdate: Birthplace (City, State, Country): The mother named above is the natural mother of the following child(ren). She was unmarried when each child was born and for the ten months immediately preceding each birth. (4) Full Name on Birth Certificate Birthdate Place of Birth (City, County, State) IT IS ORDERED based on the Request filed that the father named above is the natural father of the child(ren) listed above. Page 1 of 2 Revised June 2006 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkflow.com The name of each child listed below is changed as follows. (5) Change Name From: To: If any child named above was born in Arizona, the Clerk of Court shall send a copy of this Order to the Office of Vital Records, Department of Health Services, which shall establish a new birth certificate for each child, to include the father named above (A.R.S. 36-326(A)(3)). This Order is a judgment of the Superior Court. Pursuant to A.R.S. 25-803(D), the parent with whom the child has resided for the greater part of the last six months has legal custody of the child unless otherwise ordered by the Court. Pursuant to A.R.S. 25-501, this Order of Paternity imposes a duty of support and also provides a basis for determining issues related to custody and visitation and affords the parents all rights and responsibilities provided by Arizona law (A.R.S. 25-803(C)). Date: FOR COURT USE ONLY: Copy mailed this date [ ] Corrections Unit, Office of Vital Records Page 2 of 2 Revised June 2006 Clerk of the Court: to: [ ] IV-D Agency Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkflow.com