R-132-00 COMMONWEALTH OF MASSACHUSETTS --VOLUNTARY ACKNOWLEDGMENT OF PARENTAGE THIS IS A LEGAL DOCUMENT. PRINT OR TYPE IN PERMANENT BLACK INK. We acknowledge that we are the biological parents of the following child (Name of child as it appears on the birth certificate.): \ \ First Born in (Place of Birth) on City/Town \ Last Sex (M/F) Social Security # Year (Child's SSN--if available) Middle State \ Month - spelled out \ Day We voluntarily sign this acknowledgment to establish the child's paternity. We understand that this acknowledgment may be used to amend the child's birth certificate and the names of both parents will be on the child's birth certificate. We further understand that this acknowledgment is a legal document with the same binding effect as a court judgment of paternity. Blood and genetic tests may be used to deny paternity only in accordance with the terms described on the back of this form. Name of child to appear on the amended birth certificate: \ \ First Middle MOTHER (Name as it appears on the birth certificate.) Name \ First Residence Last \ \ Middle Last \ No. & Street Name \ State City Place of Birth \ City or Town Maiden Social Security # Zip \ Date of Birth \ State Country \ Mo. \ Day Yr. Check one: I swear or affirm that when this child was born or within 300 days of the child's birth, I was not married. I swear or affirm that when this child was born or conceived, I was married to someone other than the father of this child. I understand that this form is not effective unless it is accompanied by an Affidavit of Nonpaternity signed by the man to whom I was married or unless the court has determined that the man to whom I was married is not the child's father. I understand that signing this form is voluntary and that paternity is established as of the date that both parents sign this form and the acknowledgment is properly filed with the child's birth certificate. I have read and understand the information on both sides of this form, including the information on the process for rescinding (canceling) this acknowledgment of paternity. I understand the rights and responsibilities that result when both parents sign this form. I hereby swear or affirm under the penalties of perjury that the information above is true to the best of my knowledge and belief. Signature of Mother and affirmed under penalties of perjury that Then personally appeared before me the above-named the foregoing is her free act and deed this day of FORM READ IN Notary Public: My Commission Expires: (Name as it will appear on the birth certificate.) Name \ Middle First \ Residence FATHER \ Last \ No. & Street Name LANGUAGE My Mother's Maiden Name \ City \ State Social Security # - - Zip Place of Birth \ Date of Birth \ \ \ City or Town State Country Mo. Day Yr. I understand that signing this form is voluntary and that paternity is established as of the date that both parents sign this form and the acknowledgment is properly filed with the child's birth certificate. I have read and understand the information on both sides of this form, including the information on the process for rescinding (canceling) this acknowledgment of paternity. I understand the rights and responsibilities that result when both parents sign this form. I hereby swear or affirm under the penalties of perjury that the information above is true to the best of my knowledge and belief. Then personally appeared before me the above-named the foregoing is his free act and deed this Signature of Father and affirmed under penalties of perjury that day of FORM READ IN Notary Public: My Commission Expires: LANGUAGE American LegalNet, Inc. www.USCourtForms.com What Does It Mean If You Sign This Form? This ''Voluntary Acknowledgment of Parentage" establishes your child's paternity, after both parents have signed it and the State Registry of Vital Records and Statistics has accepted it for legal registration. ''Paternity'' is the legal relationship between a child and father. "Voluntary" means that you both freely choose to sign this form. If a child's parents are not married to each other and did not complete a voluntary acknowledgment at the hospital where the child was born, paternity is established only by: Completing this form at the State Registry of Vital Records and Statistics, the clerk's office for the city or town where the child was born, or at the Probate and Family Court, or Filing a paternity action in court. Otherwise, your child may have no father under the law, and the father's name will not be on the birth certificate. This acknowledgment may be the basis for court orders of child support, custody or visitation. Do not sign this form if either of you is not sure, or has any doubt, who the father is. If either of you is not sure who the father is, have paternity testing and get the results before signing this form. If you have any questions about the legal consequences of signing this form, consult an attorney before signing. Paternity is established as of the date both parents have signed this form, if it is properly completed and filed. Sixty days or less after both parents sign this form, it is as binding as a court judgment of paternity. If, after signing, either of you believes that the man named on this form is not the father, one of you must file a case in Probate and Family Court within 60 days of the signing, requesting the court to rescind (cancel) the acknowledgment. If you are a party to a court hearing about the child, such as a custody or child support hearing, during the 60 day period after signing, and you want to rescind (cancel) the acknowledgment, you must say so in the hearing and file a case in Probate and Family Court asking to rescind before the end of the 60 day period. Otherwise, your rights to rescind the acknowledgment will expire (run out) at the time of the hearing. After this form becomes like a court judgment of paternity, you can challenge it in court within one year only on limited grounds of fraud, duress or material mistake of fact. What Are Your Rights and Responsibilities As Parents? Both parents must support their child from birth. If your child does not live with you, a court may order you to pay child support. A parent who does not live with the child may have the right to visit and establish a relationship with the child under an agreement of the parents or a court order. The mother has custody of a child born to unmarried parents unless otherwise ordered by the court. How Will You and Your Child Benefit If You Sign This Form? The father's name will appear on the child's birth certificate if you amend the child's birth certificate. It is easier to get a child support order should the need arise. It will be easier for your child to get medical information about both of you and to be included in available health care coverage. It will be easier for your child to receive benefits such as dependent or survivor's benefits from the Department of Veterans' Affairs or from the Social Security Administration or inherit through both parents. I have read and understand the information on both sides of the Voluntary Acknowledgment of Parentage. Mother's Initials Father's Initials Date Date The fee for amending a birth certificate in Massachusetts is $25.00. A birth certificate may be amended at the State Registry of Vital Records and Statistics or in the office of the city or town clerk in the community where the child was born. For questions regarding amending the child's birth certificate or other questions regarding birth registration, call the Registry of Vital Records and Statistics at (617) 740-2630 and for questions regarding paternity establishment, paternity testing or child support, call the Massachusetts Department of Revenue, Child Support Enforcement Division at (800) 332-2733. 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