State Of Colorado - Voluntary Acknowledgment Of Paternity Template
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1
2STATE OF cOLORADO
VOLUNTARy AckNOwLEDgMENT OF PATERNITy
State File Number:
____ ____ ____ ____ - ____ ____ ____ ____ ____
AOP #:
____ ____ ____ ____ ____ ____
This is a legal document which will be used to add the father’s information to the child’s certificate of birth. The information must be printed clearly and in black ink.
Crossouts and/or white out are not acceptable. Please read the reverse of this document for the legal advisement and further information.
INSTRUcTIONS
1. If the mother was not married at the time of conception or birth or anytime in between, the mother and natural father must complete Sections A, B, and C.
2. If the mother was married at the time of conception or birth or anytime in between, and the husband is not the natural father, the mother and natural father must
complete Sections A, B, and C and the mother and husband or ex-husband must complete Section D.
3. If the mother was married at the time of conception or birth or anytime in between, and is refusing to list a father, the mother must complete Sections A & B. In
Section D, write “refused” across the (ex) husband’s area.
cHILD
First Name(s) at birth
Middle Name(s)
Last Name(s) (Name on Birth Certificate)
Title(Jr., III, etc.)
Gender
Date of Birth: mm/dd/yyyy
Facility of Birth
City of birth
County of birth
State of birth
CO
we agree the child’s name
First Name(s)
Middle Name(s)
Last Name(s)
Title(Jr., III, etc.)
shall now be shown
on the birth certificate as
MOTHER
Mother’s full name before 1st marriage (maiden)
First Name(s)
Middle Name(s)
Last Name(s) prior to first marriage (Maiden)
Street Address
City
County
State
Zip Code
Date of Birth
mm/dd/yyyy
State or Nation of Birth
Daytime Telephone Number
Social Security Number
I have been provided with written and oral advisements of my rights and responsibilities. I freely sign this Acknowledgment of Paternity. I understand this Acknowledgment of Pater-
nity will be a legal finding of paternity in 60 days or when a legal action concerning the child and me is filed, whichever comes first.
X
Date:
Signature of Mother:
wITNESS
Name of Witness
X
(please print):
Date:
Signature of Witness:
FATHER
Title(Jr., III, etc.)
First Name(s)
Middle Name(s)
Last Name(s)
Street Address
City
County
State
Zip Code
Date of Birth
mm/dd/yyyy
State or Nation of Birth
Daytime Telephone Number
Social Security Number
Race
Education (highest grade)
Hispanic Origin? (if yes, specify)
I acknowledge that I am the natural father of the child identified above. I request that my name be entered on the birth certificate as father of this child.
I have been provided with written and oral advisements of my rights and responsibilities. I freely sign this Acknowledgment of Paternity. I understand this Acknowledgment of Pater-
nity will be a legal finding of paternity in 60 days or when a legal action concerning the child and me is filed, whichever comes first.
X
Date:
Signature of Father:
wITNESS
X
Name of Witness
Signature of Witness:
(please print):
Date:
HUSBAND OR EX-HUSBAND
I acknowledge that I was married to the mother identified above at the time of conception or birth or anytime in between of the child identified above, and I am NOT the natural
father of this child.
X
Signature of Husband or Ex-husband:
Print Name
Date:
:
wITNESS
X
Name of Witness
Signature of Witness:
(please print):
Date:
MOTHER
I acknowledge that I was married to the man named above at the time of conception or birth or anytime in between of the child named above; however, he is NOT the natural father
of this child.
X
Date:
Signature of Mother:
wITNESS
X
Name of Witness
Signature of Witness:
(please print):
Date:
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