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 Middle Last Sex (M/F) Born in on M - spelled out Dayonth YearSocial Security #(Childs SSN--if available)(Place of Birth) City/Town State We voluntarily sign this acknowledgment to establish the childs paterni ty. We understand that this acknowledgment may be used to amend the childs birth certificate and the names of both parents wil l be on the childs birth certificate. We further understand that this acknowledgment is a legal document with the same binding effec t as a court judgment of paternity. Blood and genetic tests may be used to deny paternity only in accordance with the terms de scribed on the back of this form. Name of child to appear on the amended birth certificate: First Middle Last (Name as it appears on the birth certificate.) MOTHER Name First Middle Last Maiden Residence No. & Street Name Social Security # City State Zip Place of Birth Date of Birth City or Town State Country Mo. Day Yr.Check one: I swear or affirm that when this child was born or within 300 days of th e childs birth, I was not married. I swear or affirm that when this child was born or conceived, I was marr ied 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 wa s married is not the childs father. I understand that signing this form is voluntary and that paternity is e stablished as of the date that both parents sign this form andthe acknowledgment is properly filed with the childs birth certificate. I have read and understand the information on both sides of this form, including the information on the process for rescinding (can celing) 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 thatthe information above is true to the best of my knowledge and belief. Signature of Mother Then personally appeared before me the above-named and affirmed under penalties of perjury thatthe foregoing is her free act and deed this day of FORM READ IN Notary Public: My Commission Expires: LANGUAGE (Name as it will appear on the birth certificate.)FATHER Name Middle First Last My Mothers Maiden Name Residence Social Security # - - No. & Street Name City State 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 e stablished as of the date that both parents sign this form andthe acknowledgment is properly filed with the childs birth certificate. I have read and understand the information on both sides of this form, including the information on the process for rescinding (can celing) 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 thatthe information above is true to the best of my knowledge and belief. Signature of Father Then personally appeared before me the above-named and affirmed under penalties of perjury thatthe foregoing is his free act and deed this day of FORM READ IN Notary Public: My Commission Expires: LANGUAGE American LegalNet, Inc. www.USCourtForms.com>>>> 2 What Does It Mean If You Sign This Form? This Voluntary Acknowledgment of Parentage" establishes your childs p aternity, after both parents have signed it and the State Registry of Vital Records and Statistics has acc epted it for legal registration. Paternityis the legal relationship between a child and father. "Voluntary" means that you both freely choose to sign this form. If a childs parents are not married to each other and did not com plete 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 Statisti cs, the clerks 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 fathers name will not be on the birth certificate. This acknowledgment may be the basis for court orders of ch ild 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 fo rm, if it is properly completed and filed. Sixty days or less after both parents sign this form, it is as binding a s a court judgment of paternity. If, after signing, either of you believes that the man named on this for m 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 ackn owledgment, you must say so in the hearing and file a case in Probate and Family Court asking to rescind be fore the end of the 60 day period. Otherwise, your rights to rescind the acknowledgment will expire (run o ut) at the time of the hearing. After this form becomes like a court judgment of paternity, you can chal lenge 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 an d establish a relationship with the child under an agreement ofthe parents or a court order. The mother has custody of a child born to unmarried parents unless other wise ordered by the court. How Will You and