Petition For Correction Of Birth Record
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Petition For Correction Of Birth Record Form. This is a Massachusetts form and can be use in Probate And Family Court Statewide.
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Tags: Petition For Correction Of Birth Record, CJ-D 118, Massachusetts Statewide, Probate And Family Court
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court Department
Division
Docket No.
PETITION FOR CORRECTION OF BIRTH RECORD
, Petitioner
V.
in his/her official capacity
as City/Town Clerk of
, Respondent
(name of city or town)
1. Now comes the petitioner who seeks to correct the birth certificate of
.
(name of child)
The child was born on
in
(date of birth)
(city or town of birth)
in
, Massachusetts.
(county of birth)
2. Petitioner, who resides at
(Street Address)
(County)
(City/Town)
(State)
is the
(Zip)
of the child.
(relationship, i.e., mother, legal father)
3. On
State of
(date of judgment)
(name of state)
, the
,
(name of out of state court)
, entered a judgment or order establishing the paternity of the child under
the laws of that state. A CERTIFIED copy of that judgment or order is filed with this petition.
4. On or about
(date)
the petitioner presented a certified copy of the judgment or order to the
respondent with the request that the respondent prepare a new birth certificate for the child consistent with the judgment of
the Court and substitute the new certificate for the old certificate, but the respondent declined to do so.
5. Wherefore petitioner requests that this Court enter an order that the respondent prepare a new birth certificate for the child
consistent with the judgment and substitute the new certificate for the old certificate, as provided by G.L. c. 46 ยง 13.
Date
(Signature of attorney or plaintiff, if pro se)
(Print name)
(Street address)
(City/Town)
(State)
(Zip)
Tel. No.
B.B.O. #
CJ-D 118 (4/07)
C.G.F
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