Dss Form 1548 - Responsible Father Registry Notice Of Change - South Carolina Department Of Social Services

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South Carolina Department of Social Services
RESPONSIBLE FATHER REGISTRY
NOTICE OF CHANGE
NOTICE: Please identify the changes that you will be making. You must complete Part 1A and Part 4 on this
form to complete the changes.
Change to Putative Father Information
Change to Mother Information
Change to Child Information
PART 1 – PUTATIVE FATHER’S INFORMATION
A. Information Listed on File
First
Middle
Last
Date of Birth
Residential Address Listed on File:
Select County ...
Street
City
State
Zip
County (If State SC)
Mailing Address Listed on File:
(If different from residential address)
Select County ...
P.O. Box/Street
City
State
Zip
County (If State SC)
B. Information Change
New Residential Address
Select County ...
Street
City
State
Zip
County (If State SC)
New Mailing Address
(If different from residential address)
Select County ...
P.O. Box/Street
City
State
Zip
County (If State SC)
PART 2 – MOTHER’S INFORMATION
A. Information Listed on File
First
Middle
Maiden
Last
Date of Birth
Residential Address Listed on File:
Select County ...
Street
City
State
Zip
County (If State SC)
B. Information Change
New Name Change
First
Middle
Maiden
Last
New Residential Address
Select County ...
Street
City
State
Zip
County (If State SC)
New Mailing Address (If different from residential address)
Select County ...
P.O. Box/Street
City
State
Zip
County (If State SC)
DSS Form 1548 (APR 10)

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