Centralized Paternity Registry The word ‘Father’ used on this form refers to father or putative father of child born out of wedlock, 10 O.S. 1981, Section 75 06-1.1. Section A. Identifying Information: Father, Mother, and Child: Father(s) Name: ____________________________________ DOB _____________________ Father(s) Social Security No. ______________________________________________________ Father(s) Address: ______________________________________________________________ City ______________________ State __________ Zip ________ County _______________ Tribal Affiliation: ________________________________________________________________ Mother(s) Name: ____________________________________ DOB _____________________ Mother(s) Social Security No. ______________________________________________________ Mother(s) Address: ______________________________________________________________ City ______________________ State __________ Zip ________ County _______________ Tribal Affiliation: ________________________________________________________________ Child(s) Name: _________________________________________________________________ Child’s DOB or anticipated DOB _________________________________ Race of: Section B: Father(s) _____________ Mother(s) _____________ Sex ____________ Child(s) _____________ Check the Appropriate Action: ______ ______ ______ ______ Notice of intent to claim paternity Acknowledgement of paternity Revocation (cancel either of the above) Adjudication of paternity Court No. ___________________________ County Father’s Attorney: _______________________________________________________________ Attorney’s Address: ______________________________________________________________ City ______________________ State __________ Zip ________ County _______________ Date: _________________________________________________________________________ American LegalNet, Inc. www.USCourtForms.com Page 1 Section C: Change of Father’s Address: Old Address: ___________________________________________________________________ City ______________________ State __________ Zip ________ County _______________ New Address: __________________________________________________________________ City ______________________ State __________ Zip ________ County _______________ _____________________________________________________ _________________________ Signature of Father or Court Clerk Date Mail to: Oklahoma Department of Human Services – Adoptions PO Box 25352 Oklahoma City, OK 73125 Oklahoma DHS Form / AOC Form 62 Revised 7/05 Page 2 American LegalNet, Inc. www.USCourtForms.com