Arizona Acknowledgment of Paternity (CS-127)

Who can use this form

• Both parents sign. The health department's web page says the child must be under 18.
• It does not apply if the mother was married at the time of birth or in the ten months before it, unless a Waiver of Paternity Affidavit or a court order or decree rebutting paternity is attached.
• Each signature must be witnessed or notarized. A witness must be at least 18 and not related to either parent by blood or marriage.
• After the child is 3 months old, only the child's last name can be changed with this form.

What to send with it

• All pages of the acknowledgment except the completion instructions, filled in with black ink and with no corrections.
• A separate acknowledgment for each child in a multiple birth.
• Do not mail any money to the Hospital Paternity Program.
• For an amended birth certificate, the health department's web page asks for the Request for Copy of Birth Certificate (VS-11), a copy of an ID or a notarized signature, a self-addressed stamped envelope and the fee.
• The health department's web page gives a different route from the form: it says to submit the acknowledgment to a county vital records office or to the Bureau of Vital Records.

Where to send it

Mail to

DCSS Hospital Paternity Program - HPP PO BOX 64533 Phoenix, AZ 85082

State fee

The form states no filing fee and says not to mail any money to the Hospital Paternity Program. The health department's fee schedule lists $30.00 to amend or correct information in a registered birth certificate.

Typical processing

Not provided

Issued by

Arizona Department of Economic Security

Form revision

(7-22)

Source

Official government page