FOR CLERK'S USE ONLY SUPERIOR COURT OF ARIZONA MOHAVE COUNTY (1) ________________________________ Person Filing (Petitioner) (3) Case Number:____________________________ (4) ATLAS No. _____________________________ ORDER OF PATERNITY (A.R.S. §25-812F) (2) ________________________________ Other Parent (Respondent) BASED ON THE REQUEST FILED, for the minor child(ren) whose name(s) appear on birth certificate(s) as: (5) First a._____________________________ b._____________________________ c._____________________________ Middle __________________________ __________________________ __________________________ Last _____________________________ _____________________________ _____________________________ Who were born on this date and at this location (below): Month / Day / Year a. ____________________________ b. ____________________________ c. ____________________________ (6) Mother's Full Name: Maiden Name: Date of Birth: Current Address: THE COURT FINDS: (List in same order as above) City, State, Nation of Birth _________________________________________________________ _________________________________________________________ _________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ The mother was not legally married when the minor child(ren) were born or at any time during the 10 months prior to birth, and the parties agree that the natural father of the minor children is: (7) Father's Full Name: Date of Birth: __________________________________________________ __________________________________________________ Birthplace (City, State, Country): __________________________________________ Current Address: __________________________________________________ Revised 1/1/2013 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case No.________________________________ IT IS ORDERED, that the natural father of the above named child(ren) is: (8) Father's LEGAL name (as listed on his own birth certificate, or First _______________________________ current legal name) Last _____________________________ Middle __________________________ (9) For any minor child(ren) born in the State of Arizona, the CLERK OF COURT SHALL FORWARD A COPY OF THIS ORDER TO THE OFFICE OF VITAL RECORDS, which is ordered to amend the birth certificate(s) as follows: The natural father's name shall be entered as the father on the birth certificate(s). The minor child(ren)'s name(s) shall be change to: (List in same order as previous) First a._____________________________ b._____________________________ c._____________________________ Middle __________________________ __________________________ __________________________ Last _____________________________ _____________________________ _____________________________ For any minor child(ren) born in a state other than Arizona, the agency that maintains birth records in that state is requested or ordered to amend its birth records to reflect the changes ordered above. · · This Order is a Judgment of the Superior Court. Pursuant to A.R.S. §25-803(D), the parent with whom the minor child(ren) have resided for the greater part of the last six (6) months has legal decision making of the minor child(ren) 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 legal decision making and parenting time and affords the parents all rights and responsibilities provided by Arizona law A.R.S. §25-803(C). · Dated:_____________________________ VIRLYNN TINNELL, CLERK OF SUPERIOR COURT By: ________________________________________ Deputy Clerk Copy mailed this date:________________ to: Revised 1/1/2013 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com