(1) Person Filing: Mailing Address: City, State, Zip Code: Day/Evening Phone: Represented by If Attorney, Bar No.: / SELF (No Attorney) OR Attorney Atty. Phone: SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY FOR CLERK’S USE ONLY (3) Case No. (2) Person Filing (Petitioner) (4) ATLAS No. VOLUNTARY ACKNOWLEDGMENT OF PATERNITY with Affidavit of Other Parent (Respondent) Legally Presumed Father A.R.S. § 25-814 (5) The Clerk is requested to issue an order establishing paternity for the following minor children: 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 City, State, Nation of Birth (a) (b) (c) (6) Mother’s Full Name Maiden Name Date of Birth 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. © Superior Court of Arizona in Maricopa County November 8, 2007 ALL RIGHTS RESERVED Page 1 of 3 DRVPM11f USE CURRENT VERSION American LegalNet, Inc. www.FormsWorkflow.com Case No.________________ 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 custody. 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 legal custody unless otherwise ordered by the Court. 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 Father Date Signature of Witness Date Signature of Witness Date Printed name of Witness Printed name of Witness Address of Witness Address of Witness City, State, Zip Code City, State, Zip Code © Superior Court of Arizona in Maricopa County November 8, 2007 ALL RIGHTS RESERVED Page 2 of 3 DRVPM11f USE CURRENT VERSION American LegalNet, Inc. www.FormsWorkflow.com Case No._________________ Acknowledged before me this:_____________________ Acknowledged before me this: __________________ ________________________________________________ Deputy Clerk or Notary Seal/My commission expires: ______________________________________________ Deputy Clerk or Notary Seal/My commission expires: AFFIDAVIT OF LEGALLY PRESUMED FATHER A.R.S. § 25-814(A)(1) (11) I, , was legally (printed name of legally presumed father as it appears on minor children’s birth certificates) 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. OATH OR AFFIRMATION I swear or affirm the contents of this document are true and correct under penalty of law. Signature of Legally Presumed Father Date Sworn to or Affirmed before me this: Date Seal/My Commission Expires © Superior Court of Arizona in Maricopa County November 8, 2007 ALL RIGHTS RESERVED Deputy Clerk or Notary Public Page 3 of 3 DRVPM11f USE CURRENT VERSION American LegalNet, Inc. www.FormsWorkflow.com