Vr 171 Form PDF Details

In the complex panorama of administrative procedures, the VR 171 form serves a crucial function, particularly for families and individuals navigating the nuances of legal parentage in New York. Located within the labyrinthine corridors of the Office of Vital Records at 125 Worth Street, this document facilitates the acquisition of an official Acknowledgment of Parentage, marking a pivotal step in affirming the legal relationship between a parent and a child. Its significance extends beyond the mere formal recognition of a biological connection, impacting a range of legal rights, responsibilities, and access to vital records. The form requires detailed information, including the child's name, date of birth, place of birth, and certificate number, alongside the parent or guardian's details and their reason for requesting the record. The process underscores the importance of clarity and accuracy, from the stipulation that all items be printed clearly to the necessity of including a current photo identification with the application. Interestingly, the form highlights an accommodating stance towards various family structures by providing space for the names of parents or other potential parental figures, reflecting evolving social norms and legal recognitions. Furthermore, it is noteworthy that obtaining this acknowledgment incurs no fee, removing a potential barrier to formalizing parent-child relationships. The instructions at the conclusion of the VR 171 form underscore the exclusivity of the entitlement to order the record to the persons listed on the existing Acknowledgment of Parentage (AOP), ensuring a layer of privacy and protection to the involved parties. This document, thereby, encapsulates a blend of bureaucratic procedure and the acknowledgment of changing familial dynamics, positioned within the broader context of health and legal systems at the city level.

QuestionAnswer
Form NameVr 171 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesacknowledgement of paternity form nyc, vr 171, how to get a copy of acknowledgement of paternity in nyc, paternity form ny

Form Preview Example

OFFICE OF VITAL RECORDS

125 WORTH STREET, CN 4, ROOM 119 NY, NY 10013

APPLICATION FOR A COPY OF AN ACKNOWLEDGMENT OF PARENTAGE APLICACIÓN PARA UNA COPIA DE UN RECONOCIMIENTO DE FILIACIÒN

(Please print all items clearly/Por favor escriba todo claramente.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF CHILD/NOMBRE DEL NIÑO/A

 

 

 

MALE/NIÑO

 

 

DATE OF BIRTH/FECHA DE

 

 

 

 

 

 

 

FEMALE/NIÑA

 

 

NACIMIENTO

 

 

 

 

 

 

 

 

LAST/APELLIDO

FIRST/PRIMER NOMBRE

 

 

GENDER X/GENERO X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MM

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YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLACE OF BIRTH/SITIO DE NACIMIENTO

 

 

 

CERTIFICATE NUMBER/NÚMERO DEL CERTIFICADO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MOTHER/PARENT NAME BEFORE MARRIAGE/NOMBRE DE

 

 

 

FATHER/PARENT NAME/NOMBRE DEL PADRE/ Otra

 

 

LA MADRE/ Otra persona con nexo parental presunto o potencial

 

 

 

persona con nexo parental presunto o potencial

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PURPOSE FOR OBTAINING THIS RECORD/PARA QUE

 

 

 

DATE REQUESTED/FECHA DE PEDIDO

 

 

 

 

 

 

 

 

NECESITA EL CERTIFICADO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REQUESTOR PRINT/SIGN YOUR NAME AND FULL MAILING ADDRESS BELOW

 

 

 

 

 

 

 

 

 

FAVOR DE ESCRIBIR/FIRMAR SU NOMBRE Y SU DIRECCIÓN

 

 

 

 

 

 

 

 

 

 

 

 

 

PRINT NAME/ESCRIBA SU NOMBRE

 

 

 

SIGNATURE/FIRME SU NOMBRE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS/DIRECCIÓN

 

 

 

 

 

 

 

APARTMENT NO./APARTAMENTO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY/CIUDAD

STATE/ ESTADO

ZIP CODE/CÓDIGO POSTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DAYTIME TELEPHONE NO./TELÉFONO DE DÍA

 

 

 

HOME TELEPHONE NO./TELÉFONO DE SU HOGAR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AREA BELOW FOR DEPARTMENT OF HEALTH AND MENTAL HYGIENE USE

ONLY SOLO PARA USO DEL NYC DEPARTAMENTO DE SALUD

 

DATE RECEIVED:

 

 

DATE RETURNED:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LDSS-5171 LOCATED (Copy attached)

 

 

LDSS-5171 NOT LOCATED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PREPARED BY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VR 171 (Rev. 2/21)

Instructions:

Only the person(s) listed on the existing AOP are entitled to order the record.

Please include a copy of your current photo Identification with this application.

There is no fee to order an existing AOP.

Mail the completed application to:

New York City DOHMH

Office of Vital Records Services

125 Worth Street, CN 4, Room 119

NY, NY 10013