Arkansas Acknowledgement Paternity Form – Fill Out and Use This PDF

ACKNOWLEDGMENT OF PATERNITY

Please read these instructions before filling out this form. Read the important information about your rights and responsibilities on the back of this form.

1.This Acknowledgment of Paternity may not be signed before your child is born.

2.This is a legal document. Type or complete in black ink and do not alter.

3.Fill in all of the spaces. List your insurance even if it will not cover the hospital bill for your child’s birth. If you do not have insurance, write “none” in that space. Disclosure of your Social Security Number is mandatory under P. L. 104-193 and may be used for child support purposes.

4. Each parent must sign in the presence of a notary public. Show the notary identification with your picture, such as a driver’s license or school ID. If the notary uses a rubber stamp they must stamp both the mother’s and father’s signatures and on each copy.

5.If you are completing this form at the hospital when your baby is born, tell the staff when you are ready to sign. They will help you with the notary and mail it for you. If you give the completed Acknowledgment for Paternity to the hospital staff responsible for birth certificates before the birth certificate is sent to the Division of Vital Records, there is no filing fee. Note: there will be a charge of $12.00 for a copy of the birth certificate when you order it from the Division of Vital Records.

6.If you are completing this form after the hospital has sent the birth certificate to the Division of Vital Records, remember to sign this Acknowledgment in front of a notary public. If the notary uses a rubber stamp they must stamp both the mother’s and father’s signatures and on each copy. If you want to change your child’s last name, carefully read and follow the directions under the child’s information section on the Acknowledgment of Paternity form. The parents should keep the blue copies of this form. Send the white (original) to the Office of Child Support Enforcement and the white (copy) to the Division of Vital Records at the addresses shown below.

Office of Child Support Enforcement	Division of Vital Records
P. O. Box 8133	Arkansas Department of Health
Little Rock, Arkansas 72203	4815 West Markham, Slot 44
	Little Rock, Arkansas 72205

For a copy of an updated birth certificate enclose a fee of $27.00 with the white copy. This $27.00 includes $15.00 for the filing fee and $12.00 for a copy of the birth certificate.

7.This Acknowledgment of Paternity may be signed for any child who was born in Arkansas. It can be mailed to a parent anywhere to be signed in the presence of a Notary.

8.If the mother was married when she became pregnant or anytime while she was pregnant, but the husband is not the biological (natural) father, follow the instructions on the back of this Acknowledgment of Paternity (Denial of Husband’s Paternity). An acknowledgment denying paternity must be submitted before the hospital submits the birth certificate to the Division of Vital Records.

9.Any person signing a voluntary acknowledgment of paternity may change their mind and rescind their acknowledgement. To do this, you should complete a rescission form and file it with the Division of Vital Records. You may request a rescission form by calling the Division of Vital Records at 1-800-637-9314. The rescission form must be filed prior to any administrative or judicial proceeding regarding the child takes place, or within sixty (60) days from the date the voluntary acknowledgment is signed, which ever comes first. After sixty (60) days, the only way to change the established parents of the child is to file a motion with the court. A motion, if filed, must be based on a claim that the signing of the acknowledgment was because of fraud, duress, or material mistake of fact. You may want to discuss with your attorney what facts might be needed to prove these claims.