Determination Of Paternity Form 1998
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1
2DETERMINATION OF PATERNITY
THE INFORMATION ON THIS FORM IS USED TO CREATE A NEW BIRTH CERTIFICATE
Section 3705.09 of the Ohio Revised Code states that when a man is presumed or found to be the
father of a child according to Chapter 3111 of the Revised Code or the father has acknowledged
the child as his in accordance with former Section 2105.18 and current section 5101.314 of the
Revised Code, and documentary evidence of such fact is submitted to the Ohio Department of
Health in such form that may be required, a new birth record shall be established.
CHILD'S PERSONAL DATA
Name of Child from Original Birth Record (First, Middle and Last)
Name of Child after Determination of Paternity (First, Middle and Last)
Place of Birth (City, County, State)
Date of Birth (Month, Day, Year)
Sex
Mother's Maiden Name
SSN:
Mother's Name at Time of the Child’s Birth (First, Middle and Last)
FATHER'S PERSONAL DATA
ALL INFORMATION IS TO BE GIVEN AS OF THE TIME OF THE CHILD'S BIRTH
Full Name of Father
SSN:
Place of Birth (State or Foreign Country)
Date of Birth (Month, Day, Year)
Race (American Indian, Black, White, etc.
Origin or Descent (Italian. Mexican, German. English, etc.)
Of Hispanic Origin? Yes or No (If yes, specify)
Usual Occupation
Kind of Business or industry
Education (Highest Grade Completed)Grades
1-12 or college 1-4 or 5+
CERTIFICATION
State of ______________________________
County of _______________________________
I hereby certify that __________________________________________________ was determined to be the father of the above named
(Father's Name)
child on _____________________________, Case No. ________________________ and order the Ohio Department of Health to create
(Date)
a new birth record for this child.
CHILD SUPPORT ENFORCEMENT AGENCY
COURT OF __________________________________
DIVISION OF ________________________________
______________________
COUNTY OF
__________________________________________
_____________________________________________
Administrative Hearing Officer of the Agency
Judge, Magistrate or Deputy Clerk
HEA 3029 (Rev. 6/98)
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