Tennessee Rescission of Voluntary Acknowledgment of Paternity (PH-3490)
Official state formParentage and paternityForm PH-3490Free downloadLast verified November 10, 2026
Sworn form to cancel a Voluntary Acknowledgment of Paternity. The father's name is removed from the birth certificate only if the Tennessee Office of Vital Records receives it within 60 days of signing. English and Spanish.
Who can use this form
- The parent who signed the Voluntary Acknowledgment of Paternity.
- The form must be received within 60 days after the acknowledgment was signed in front of a notary public.
- The rescission itself is also signed in front of a notary public.
What to send with it
- The completed affidavit, signed in front of a notary public.
- A $15.00 check or money order payable to Tennessee Vital Records.
- An extra $15.00 for each certified copy of the changed birth certificate.
Where to send it
- Mail to
- Tennessee Vital Records Office Andrew Johnson Tower, 1st Floor 710 James Robertson Parkway Nashville, Tennessee 37243
- State fee
- $15.00, as printed on the form. Each certified copy of the changed birth certificate is $15.00 more.
- Typical processing
- Not provided
- Form revision
- rev. 06/2015
- Source
- Official government page