Dh Form 432 Acknowledgment Of Paternity

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ACKNOWLEDGMENT OF PATERNITY

TYPE OR PRINT IN BLUE OR BLACK INK

THIS FORM MUST BE SIGNED BY BOTH MOTHER AND FATHER IN THE PRESENCE OF A NOTARY PUBLIC OR BEFORE TWO WITNESSES.

IMPORTANT - Read Information and Instructions on the reverse side of this form and acknowledge your understanding by signing at the bottom

of the reverse side of this form as well as below under "Acknowledgment By Natural Parents".

INFORMATION TAKEN FROM ORIGINAL BIRTH CERTIFICATE

Child's SSN: ___________________________________

State File/Birth Number: _____________________________

(If Known)

Full Name of Child: _____________________________________________________________________________

Sex: _________________

(First)

(Middle)

(Last)

Child's Date of Birth: ___________________

Child's Place of Birth: ____________________________________________________________

(City)

(County)

(State)

(Zip)

(Month/Day/Year)

Mother's Full

Mother's Place of Birth

Maiden Name: ______________________________________________________________

__________________________________________

(First)

(Middle)

(Last)

(State

Country)

Mother's Social Security Number: ______________________________________

Mother's Date of Birth: _____________________________

(Month/Day/Year)

INFORMATION FOR NEW BIRTH CERTIFICATE

Full Name of Child for New Birth Certificate: ________________________________________________________________________________

(See Reverse Side of form)

(First)

(Middle)

(Last)

(Suffix)

Natural Father's

Full Name:

__________________________________________________________________________________________________________

(First)

(Middle)

(Last)

Date of Birth

of Father:

_______________________________________________

Father's Social Security Number: ______________________________

(Month/Day/Year)

Place of Birth

of Father:

_____________________________________________________________________

Father's Race: _______________________

(City)

(County)

(State)

Residence Address

Mailing Address of

Of Father:

___________________________________________

Father if Different: __________________________________________

(Street/Box No./Route)

____________________________________________________

______________________________________________________

(City)

(County)

(State)

(Zip)

(City)

(County)

(State)

(Zip)

Current Mailing Address of Mother

_____________________________________________________________________________________________________________________

(Street/Box No./Route)

(City)

(State)

(Zip)

NOTE: If married after child's birth and now request amendment of marital status on birth record, send certified copy of marriage record with this

form. If married in Florida and you require a certified copy, fill-in data below and send $5.00. A certified copy will be sent to you upon completion,

if married in Florida: Date: _______________________________________ County issuing license: ____________________________________

ACKNOWLEDGMENT BY NATURAL PARENTS

Under penalties of perjury, WE HEREBY DECLARE that we have read the foregoing Acknowledgement of Paternity and that the facts stated in it are

true, that is, that the mother was unwed at the time of birth, that no other man is listed on the birth record as father, that we are the natural parents of the

child named above and that we fully understand our responsibilities and rights printed on the reverse side of this form, DH 432, (11/04). WE FURTHER

DECLARE that no court action establishing paternity has occurred or is in process. We understand that a person who knowingly makes a false

declaration pursuant to s. 92.525(2) or 382.026(1), Florida Statutes is guilty of perjury by false written declaration, a felony of the third degree,

punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

IF NOTARIZED

Sworn to and subscribed before me this ____Day of _________, 20___,

______________________________________________________________

(Signature of Natural Father)

(Signature of Natural Mother)

_______________________________________________

(Printed Name of Natural Father)

(Printed Name of Natural Mother)