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Denial Of Paternity Form. This is a Oklahoma form and can be use in District Court Statewide.
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Tags: Denial Of Paternity, Oklahoma Statewide, District Court
*03PA210E-001*
OKLAHOMA DEPARTMENT OF HUMAN SERVICES
Denial of Paternity
This is a legal document. Type or print in ink by pressing hard. No cross outs,
correction fluid, or alterations allowed.
Complete this form only when the child is born during the marriage or within 300 days
after the marriage is terminated and the presumed father is NOT the natural father. The
person that needs to sign this Denial of Paternity form is the presumed father, as
described on the back of this form. The presumed father agrees that he is not the
natural father of the child. The child must be less than two years old.
Completion of this Denial of Paternity by the presumed father AND Form 03PA209E,
Acknowledgment of Paternity, by the natural father, allows the child's birth certificate to
include the natural father's name.
Section l. Child's information as it now appears on birth certificate
Child's first name
Middle
Date of birth (mo/day/yr)
Last
Sex, check one
Female
Male
County
State
City of birth
Last
Maiden name
Section II. Mother's information
Mother's first name
Middle
Section III. Presumed father's information
Presumed father's first name
Social Security number
Present street address
Middle
Date of birth (mo/day/yr)
City
Last
Suffix
Area code Daytime phone number
State
Zip code
Section IV. Presumed father's signature
By signing below, I declare under penalty of perjury that I have read and understand
this Denial of Paternity. I declare the information in this Denial is true and:
1. I am the presumed father of the child identified on this form.
2. I am NOT the natural father of the child identified on this form.
3. I have not acknowledged paternity of this child.
4. No court has determined that I am the father of this child.
5. I understand the name of the natural father will be placed on the child's
birth certificate.
Presumed father 's signature
Signature of witness
Date and place
Printed name of witness
You have the right to withdraw your denial within 60 days after the effective date of the
Acknowledgment of Paternity. You must file a signed Form 03PA213E, Rescission of
Denial of Paternity, with the Oklahoma State Department of Health (OSDH), Division of
Vital Records. To obtain Form 03PA213E, call 405-522-2273 in the Oklahoma City
calling area, 918-295-3500 in the Tulsa calling area, 1-800-522-2922 toll free, or contact
your closest child support office or OSDH Division of Vital Records.
Distribution of copies: white to OSDH Division of Vital Records, yellow to OKDHS
Oklahoma Child Support Services (OCSS), pink to Mother, gold to Presumed Father.
Issued 11-1-2006
03PA210E (CSED-209-D)
Page 1 of 2
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03PA210E (CSED-209-D)
Denial of Paternity
Information for completing this Denial of Paternity
Please read these instructions and the entire form before you sign it.
A man is presumed to be the father of a child if:
1. he and the mother of the child are married to each other and child is born during
the marriage;
2. he and the mother of the child were married to each other and the child is born
within 300 days after the marriage is terminated by death, annulment,
declaration of invalidity, dissolution of marriage, or after a decree of separation;
3. before the birth of the child, he and the mother of the child married each other
in apparent compliance with law, even if the attempted marriage is or could be
declared invalid, and the child is born during the invalid marriage or within 300
days after its termination by death, annulment, declaration of invalidity, a
decree of separation, or dissolution of marriage;
4. after the birth of the child, he and the mother of the child married each other in
apparent compliance with law, whether or not the marriage is or could be
declared invalid, and he voluntarily asserted his paternity of the child, and:
•
•
•
the assertion is in a record with the Oklahoma State Department of Health
(OSDH), Division of Vital Records, or OKDHS;
he agreed to be and is named as the child's father on the child's birth
certificate; or
he promised in a record to support the child as his own; or
5. for the first two years of the child's life, he resided in the same household with
the child and openly held out the child as his own.
Only a presumed father may sign a Denial of Paternity. The denial is valid only if:
1. an Acknowledgment of Paternity is signed by another man and is filed with the
OSDH Division of Vital Records;
2. the denial is in writing and is signed under penalty of perjury;
3. the presumed father has not previously:
• acknowledged his paternity, unless the previous acknowledgment has been
rescinded or successfully challenged; or
• been determined to be the father of the child by a court; and
4. the denial is signed before the child is two years old.
If the presumed father is unwilling or unable to sign this denial, the presumed father will
be the legal father of the child and will be named as the father on the birth certificate.
When the presumed father will not sign, the only way to remove the presumed father's
name and add the natural father's name on the child's birth certificate is by court order.
Instructions for completing this Denial of Paternity
After this form has been completed, signed and witnessed, give the pink copy to the
mother and the gold copy to the presumed father. Do not separate the other pages of the
Denial. Mail the white and yellow copies of this Denial and Form 03PA209E,
Acknowledgment of Paternity, to:
Oklahoma State Department of Health
Division of Vital Records
P. O. Box 53551
Oklahoma City, OK 73152
Disclosure of your Social Security number, and the Social Security number of your child,
is required by federal law. [42 USC §666] OCSS will use these Social Security numbers
only for the purpose of establishing paternity and, if requested or required to do so,
establishing and enforcing support for you and your family.
Page 2 of 2
Issued 11-1-2006
American LegalNet, Inc.
www.FormsWorkFlow.com