Louisiana Revocation of Authentic Act of Acknowledgment of Paternity
Official state formParentage and paternityFree downloadLast verified November 10, 2026
Notarized affidavit to revoke an Acknowledgment of Paternity, without cause, within 60 days of signing it. It is filed with the Louisiana Vital Records Registry Central Office. The father's name is removed from the birth certificate and the child's surname reverts to the mother's maiden name.
Who can use this form
- Any person who signed or concurred on the Acknowledgment of Paternity
- It must be filed within 60 days of the date the acknowledgment was signed.
- It must be signed before a notary public and two competent witnesses.
What to send with it
- The entire form completed, notarized and witnessed by two competent witnesses
- Copy of your ID
- The $27.50 statutory fee by check or money order payable to Louisiana Vital Records
- Mail it so it is date stamped by the post office within 60 days of signing the acknowledgment.
Where to send it
- Mail to
- Center for Vital Records and Statistics P.O. Box 60630 New Orleans, Louisiana 70160-0630
- State fee
- $27.50 statutory fee, by check or money order payable to Louisiana Vital Records.
- Typical processing
- Not provided
- Form revision
- VR Rev. 12/25
- Source
- Official government page