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Michigan Affidavit Of Parentage - Mail Or Counter Application For A Certified Copy Form. This is a Michigan form and can be use in General Statewide.
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MAIL OR COUNTER APPLICATION FOR A CERTIFIED COPY
MICHIGAN AFFIDAVIT OF PARENTAGE
State File Number (If Known)
www.michigan.gov/mdch
NOTE: The Michigan Vital Records office has Affidavit of Parentage forms that were filed in the Central Paternity Registry with the state since June 1,
1997. If the Affidavit of Parentage form you are requesting was filed prior to June 1, 1997, please contact the Probate Court in the county where the
mother resided at the time of signing or the Probate Court in the county where the child was born.
APPLICANT
(PERSON REQUESTING AFFIDAVIT OF PARENTAGE RECORD)
PLEASE PRINT CLEARLY AND LEGIBLY
Applicant=s
Name:
Driver=s License or
State Identification #:
Address:
City/State:
Daytime Phone Required:
(
Other Phone:
)
To protect you from identity theft, we require PHOTO
Zip:
(
)
IDENTIFICATION to be presented along with this application.
ARE YOU ELIGIBLE TO REQUEST AND RECEIVE THIS AFFIDAVIT OF PARENTAGE RECORD?
(See back for details)
PLEASE CHECK THE BOX THAT APPLIES TO YOU
ELIGIBILITY: Effective March 31, 2003, Michigan law limits who can receive a certified copy of a Michigan Affidavit of Parentage record filed in the Central
Paternity Registry since June 1, 1997. You must select which category qualifies you to request and receive the Affidavit of Parentage record.
9
9
9
9
9 Heir of the deceased person named in the
Mother named on the Affidavit of Parentage
Father named on the Affidavit of Parentage
Child named on the Affidavit of Parentage
Legal guardian of one of the persons named on Affidavit of Parentage
Affidavit of Parentage
(Must provide information below)
Specify relationship _______________________________
Date of death (Year) ______________________________
(Copy of court documented guardianship papers required)
9 Legal representative of one of the persons named on Affidavit of Parentage
(Official letter required; provide your state license number and name the person represented)
9 Court of competent jurisdiction (Court order required)
Name at time of death ____________________________
Place of death ___________________________________
(City, County, State)
STATEMENT OF ENTITLEMENT: Misstating an identity or assuming the identity of another person is subject to criminal penalties, e.g., Michigan Compiled Laws
333.2882(1)(f)) and 333.2891(1-4) and federal laws relating to falsification in obtaining an Affidavit of Parentage record.. By signing this application, I state that I am
eligible to receive this Affidavit of Parentage record as indicated in the Eligibility Section of this application.
K
APPLICANT=S SIGNATURE: (Sign Here)
=
___________________________________________________________________________________
MUST BE SIGNED, PHOTO IDENTIFICATION PROVIDED AND SEARCH FEE PAID IN ORDER TO PROCESS REQUEST
(If any birth information is unknown, please indicate A unknown@
@
REQUESTED INFORMATION FOR AFFIDAVIT OF PARENTAGE RECORD
NAME
AT
BIRTH
First
Middle
Last
CHILD=S DATE OF BIRTH
=
(mm/dd/yyyy)
First
Middle
Last
MOTHER=S DATE OF BIRTH
=
(mm/dd/yyyy)
First
Middle
Last
FATHER=S DATE OF BIRTH
=
(mm/dd/yyyy)
MOTHER=S
=
NAME
FATHER=S
=
NAME
AFFIDAVIT OF PARENTAGE REQUEST FEES
Search (Non-Refundable)
Includes One Certified Copy
$26.00
$
_______ Additional Copies (Each)
$12.00
$
EXPEDITED SEARCH * (Non-Refundable)
(In addition to regular search fee)
$10.00
Add=l
$
TOTAL ENCLOSED:
WE CANNOT PROCESS YOUR REQUEST WITHOUT PAYMENT.
IF MAILING, PLEASE REMEMBER TO INCLUDE CHECK OR
MONEY ORDER.
$
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PAYMENT - NO ORDER WILL BE PROCESSED WITHOUT
PROPER FEE SUBMITTED WITH A SIGNED APPLICATION
AND PHOTO IDENTIFICATION
SEARCH FEES ARE NON-REFUNDABLE: Fees are established
by state statute. A search fee covers the cost of a basic 3-year
search and includes either one certified copy of the record or an
official statement that the record is not filed with the state. A
basic search includes the files for the year specified as the birth
year, as well as the year before and the year after.
REFUNDABLE FEES: Payment for additional copies will be
refunded if the search indicated that the record is not filed with
the state.
A refund check would be mailed to you by the
Department of Treasury, usually within 3-4 weeks.
TURN-AROUND TIME - For regular or expedited mail
requests, please allow at least seven days for mailing and
our department=s receipting of your payment.
=
REGULAR SEARCH - Processing time will be 4 weeks.
* EXPEDITED SEARCH - If you pay the expedited search fee (in
addition to the regular search fee), a counter request will be
processed in 1-3 hours. For a mail request, the processing time
will be 2 weeks.
APPLYING IN PERSON
If you wish to apply in person to order a Michigan vital record, you
may do so at the office located at 201 Townsend St, Capitol View
rd
Building, 3 Floor, Lansing MI 48913. Lobby hours are 8:00 am 5:00 pm. Directions are available by logging onto our website at:
www.michigan.gov/mdch or by calling 517-335-8666.
A check or money order is preferred, and orders in our lobby
must be placed by 3:00 pm in order to request same-day service.
An additional fee of $10.00 is required for same-day service
orders. Please allow a 2-3 hour waiting period for same-day
service.
PHOTO ID REQUIREMENTS FOR APPLYING IN PERSON OR
BY MAIL FOR A MICHIGAN AFFIDAVIT OF PARENTAGE
RECORD
* Please Send Photocopies - Not Original Documents
Under Michigan law, Affidavit of Parentage records are restricted
documents, and a current valid, photo identification is required in
order to establish eligibility to request and/or receive one. To
protect you and the community from identity theft, we require a
copy of the applicant=s photo identification to be presented along
with the application.
At least one of the following photo ID=s:
=
<
PAYMENT MUST BE MADE IN U.S. FUNDS BY
CHECK OR MONEY ORDER PAYABLE TO THE:
<
<
ASTATE OF MICHIGAN@
@
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IF REGULAR SEARCH MAIL TO:
Vital Records Requests
PO Box 30721
Lansing MI 48909
Or, if you do not have one of the above, at least one of the
following photo ID=s, with stated supporting documents:
=
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IF EXPEDITED (RUSH) SEARCH MAIL TO:
Vital Records RUSH
PO Box 30721
Lansing MI 48909
Michigan driver=s license unexpired or expired for not
more than one year
State of Michigan identification card unexpired or
expired for not more than one year
Driver=s license or official identification card issued by
another state in the U.S., jurisdiction or territory,
unexpired, or expired for not more than one year.
Unexpired U.S. or foreign passport
U.S. military identification, military dependent
identification or veteran=s identification
<
<
Employment identification with photo, accompanied with
a pay stub or W-2 form
School, university or college identification with photo,
accompanied with a report card or other proof of current
school enrollment
Michigan driver=s license expired for more than one
year, accompanied by a motor vehicle registration or
title, a bridge card, MI-Health card, inmate probation or
discharge documents, a veteran=s DD-214, or an original
copy of an Affidavit of Parentage
Department of Corrections identification card,
accompanied by probation or discharge papers
If an inmate currently incarcerated, a Department of
Corrections identification card, accompanied by a
verification of incarceration by the facility on letterhead
FOR ADD=L INFO:
=
(517) 335-8666
<
DCH-0569-AOP Rev 3/9/06 By Authority of MCL 333.2882(1)(f) and MCL 333.2891(1-4)
If you are unable to provide any of the above mentioned
forms of identification, please contact the Michigan Vital
Records Office at 517-335-8666 and speak with a customer
service representative.
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