3612EN | May 2019

1

How Do I Request a Copy of my Washington State Acknowledgment of Parentage?

Should I read this?

Yes, if your child was born in Washington

State to unmarried parents.

Who should not read this?

Do not use this if:

Your child was born in another state.

You were married to the other parent

at the time the child was born.

What is an Acknowledgment of Parentage?

It is a special form for a woman who gave

birth to a child and another person seeking

to establish a parent-child relationship. In

Washington, they often give the mother this

form in the hospital right after a child’s birth.

This form is attached.

If filed with the Washington State

Department of Health, the Acknowledgment

can have the same legal effect as a court

order making the person the legal parent.

Is an Acknowledgment of Parentage the same thing as a Paternity Affidavit?

Yes. It has been known as a Paternity

Affidavit, Paternity Acknowledgment, or

Acknowledgment of Paternity. The form’s

name changed again on January 1, 2019.

How does an Acknowledgment of Parentage work?

The woman who gave birth to the child and

the person seeking to establish a parent-

child relationship must sign it. Then

someone must file it with the Department of

Health. If no one rescinds it (takes back

their signature) within sixty days after its

filing, it is a final legal determination of

parentage.

What rights do I get from signing and filing the Acknowledgment?

You get all a parent’s legal rights and

responsibilities, including

The right to ask for custody or

visitation

The responsibility to provide

financial support for the child

I signed and filed an Acknowledgment of Parentage. Do I get custody of the child now?

No. An Acknowledgment of Parentage by

itself does not establish custody, visitation,

or child support. After you file it, either

parent (or, if the child gets public assistance,

the State) can ask for a child support order

through the Division of Child Support (DCS)

or in court. You can also file a court action

asking for a custody or child support order.

Do I need to keep a copy of my Acknowledgment of Parentage?

Probably. It is official proof of your child’s

parentage. You usually should keep a copy

of it in a safe place.

If you are filing a Petition for Parenting Plan/Residential Schedule or Child Support, you must attach a certified (official) copy of the Acknowledgment of Parentage.

3612EN | May 2019

2

I signed an Acknowledgment of Parentage stating I am not a child’s parent. Should I keep a copy for myself?

Yes. You might need it if there is a future

question about the child’s parentage.

I do not remember the date we filed the Acknowledgment of Parentage. How can I find out?

You can get a certified copy from the

Department of Health. It shows the date of

filing. See the Parentage Verification Order

Form attached.

What if I just want to know if an Acknowledgment of Parentage ever got filed?

If you signed it, contact the Department of

Health at (360) 236-4300. They may be able

to tell you if an Acknowledgment is on file

there.

Due to confidentiality concerns, they cannot

give you other info, such as the date it was

filed. To get that more info, you must write

the Department of Health for a certified

copy.

If you are not one of the people who signed the Acknowledgment, the Department of Health will not send you a copy. If you need a copy of an Acknowledgment that you did not sign, talk to a lawyer, or file a motion with the court for a court order releasing the Acknowledgment to you.

How do I ask for a copy of my Acknowledgment of Parentage?

Fill out and mail the form at the end of this

publication. Attach a check or money order

for $15 for each copy you want. Make it

payable to the Department of Health.

It may take up to four weeks to arrive.

Where can I get more info?

Check the WA Department of Health

website:

www.doh.wa.gov/LicensesPermitsan

dCertificates.

If you have other questions, contact

the Department of Health at (360) 236-4300 or parentage@doh.wa.gov.

The state law about Acknowledgment

of Parentage is RCW 26.26A.205.

This publication provides general information concerning your rights and responsibilities. It is not intended as a substitute for specific legal advice.

This information is current as of May 2019.

© 2019 Northwest Justice Project — 1-888-201-1014

(Permission for copying and distribution granted to the Alliance for Equal Justice and to individuals for non-commercial purposes only.)

Center for Health Statistics P.O. Box 9709 Olympia, WA 98507 360-236-4300 Fees: $18 Filing Fee $20 Birth Certificate THIS IS A LEGAL DOCUMENT

ACKNOWLEDGMENT OF PARENTAGE

DOH 422-159 April 2019

READ THE INSTRUCTIONS CAREFULLY ON PAGES 3 & 4. ITEMS 1-29 ARE REQUIRED.

Print Name of Witness or Notarial Officer

Signature of Witness or Notarial Officer

Print Name of Birth Parent (Mother)

Print Name of Witness or Notarial Officer

Signature of Witness or Notarial Officer

Print Name of Parent/Father

Notary Use Only

Notary Use Only

Date (MM/DD/YY)

Date (MM/DD/YY)

Only check this box if another person will be denying parentage. (See page 4 for more information)

What parent labels would you like displayed on the birth certificate? (If not selected, the default is Mother/Father)

Mother/Father Parent/Parent

CH

ILD

1. Child’s First Name 2. Middle Name 3. Last Name

4. City or County of Birth 5. Date of Birth (MM/DD/YYYY)

6. Place of Birth – Name of hospital or location where child was born

BIR

TH

PA

REN

T/M

OTH

ER 7. Birth Parent’s (Mother) First Name 8. Middle Name 9. Last Name as it appears on your birth certificate

10. Date of Birth (MM/DD/YYYY)

11. Birthplace (State, or Territory/Foreign Country)

12. Telephone ( )

13. Email

14. Street Address 15. City 16. State 17. Zip

PA

REN

T/F

AT

HER

18. Parent/Father’s First Name 19. Middle Name 20. Current Legal Last Name

21. Date of Birth (MM/DD/YYYY) 22. Birthplace (State, or Territory/Foreign Country) 23. Social Security Number

24. Telephone ( )

25. Email

26. Street Address 27. City 28. State 29. Zip

Each party must sign this acknowledgment in the presence of either a notarial officer OR third party witness, not both. All fields are

required, except for the notarial appointment expiration date when signed by a third party witness. Each party declares under penalty of perjury under the laws of the state of Washington that they have been provided with and understand the rights and responsibilities, as written on the back of this form, and that the information they have provided is true and correct. Each party affirms that no other individual can legally claim parentage of the child and accepts the responsibility to provide child support as determined by applicable law. Birth parent’s (Mother) signature__________________________________________________ Signed and sworn to me before me on ____________ by_______________________________ ______________________________________________ ___________________________________ My appointment expires ___________________

Parent/Father’s signature________________________________________________________ Signed and sworn to me before me on _____________ by______________________________ ______________________________________________

____________________________________ My appointment expires __________________

Place notary

seal here

Place notary

seal here

Center for Health Statistics P.O. Box 9709 Olympia, WA 98507 360-236-4300 Fees: $18 Filing Fee $20 Birth Certificate THIS IS A LEGAL DOCUMENT

Page 2 of 4

DOH 422-159 April 2019

STATEMENTS OF ACKNOWLEDGMENT

By signing this form, you declare under penalty of perjury under the laws of Washington State that you understand the

following:

The Acknowledgment of Parentage (AOP) is a legally binding form. The legal basis for this form are chapters

26.26A and 26.26B of the Revised Code of Washington (RCW).

This form is voluntary and does not require a court proceeding. Alternatively, you may choose to establish

parentage through state or tribal court.

You have the right to talk with an attorney before signing this form. If you do not understand this information or have

further questions, you should talk to an attorney.

You have received oral information about your rights and responsibilities by doing one of the following: (1) watched a video, (2) listened to a phone message by calling 1-800-356-0463, or (3) speaking with a hospital employee or attorney.

Once the AOP is signed and filed with Department of Health, Center for Health Statistics, the parent’s name will be added to the child’s birth record (RCW 26.26A.200 and 26.26A.215).

Once the AOP is signed, both parents will be legally responsible for financially supporting this child.

If you are not sure that you are the parent of the child and the child resides in Washington State, you may open a child support case with the Division of Child Support (DCS). In most cases, you will be required to submit to genetic tests to decide parentage. The genetic parent may be responsible for the costs of the test. To locate the DCS office nearest to you, call 1-800-442-5437. You can find additional information about parentage establishment in the booklet entitled “Establish Parentage for Your Child’s Sake.” It is available at hospitals, birthing centers, and DCS offices (RCW 26.26A.300 through 26.26A.515).

Any individual who signed an AOP or Denial of Parentage (DOP) may change their mind and rescind (which means to revoke or cancel). To rescind, a Rescission of Parentage form must be filed with the Department of Health, Center for Health Statistics within a maximum of 60 days after the AOP or DOP is filed or before the first court proceeding, which ever happens first (RCW 26.26A.235).

A challenge to either an AOP or a DOP after the period for rescission has passed is permitted only for limited reasons including fraud, duress, or factual mistake. It must be brought to Superior Court and the challenger has the burden of proof. A challenge must be brought within 4 years from the date the AOP is filed with the Department of Health, Center for Health Statistics (RCW 26.26A.235 through 26.26A.245).

Only a court may determine custody and visitation issues for the child. Either parent may ask Superior Court to make residential provisions or a parenting plan after the 60-day rescission period has elapsed. The court may require the parent to pay costs (RCW 26.26A.400 through 26.26A.515).

For the purpose of this form, “witnessed” means at least one individual who is authorized to sign has signed a record to verify that the individual personally observed a signatory sign the record (RCW 26.26A.010(23)). A person signing the witnessed statement must be at least 18 years of age and not related by blood or marriage to the individuals who sign a voluntary acknowledgment of parentage, denial of parentage, or rescission of parentage form.

“Notarial officer” means a notary public or other individual authorized to perform a notarial act (RCW 42.42.010(9)).

Center for Health Statistics P.O. Box 9709 Olympia, WA 98507 360-236-4300 Fees: $18 Filing Fee $20 Birth Certificate THIS IS A LEGAL DOCUMENT

Page 3 of 4

DOH 422-159 April 2019

INSTRUCTIONS FOR ACKNOWLEDGMENT OF PARENTAGE FORM

Each parent should carefully read these instructions before completing and signing the Acknowledgment of Parentage

(AOP) form. The AOP must be either notarized or witnessed by a third party, not both, to be filed with the Department of

Health, Center for Health Statistics. We cannot file forms with missing information and will return the forms to the

birth parent/mother.

Instructions for completing the AOP:

Each parent must sign page 1 in the presence of a notary or third party witness.

The third party witness or notary must sign, print their name, and date on page 1.

Submit completed AOP with a non-refundable $18 check or money order payable to DOH. (No payment is required when parents return this AOP to the hospital within 5 days of birth. The hospital must submit the AOP within 10 days to DOH.)

If you want to order a birth certificate with both parents listed, you must submit a Certificate Order Form with a $20 check or money order payable to DOH.

Send all forms and payments to:

Department of Health Center for Health Statistics PO Box 9709 Olympia, WA 98507

What is an AOP? An AOP is a legal form used to add a second parent to a child’s birth certificate. By filing this form, you establish a parent – child relationship or “parentage.” When can an AOP be used? An AOP can only be used if:

Everyone agrees,

No other person claims to be the parent of the child. Who can Sign an AOP? An AOP must be signed by the mother/birth parent and the second parent/father of the child. You and the mother/birth parent of the child can use the AOP form if any of the following situations apply:

If you are the genetic father/parent of the child, but have never married the mother/birth parent.

If you are or were married to the mother/birth parent anytime during the pregnancy, but are not listed on the birth certificate.

If you married the mother/birth parent after the child was born.

If you lived in the same household with the child for the first 4 years of their life and consider the child as your own.

If you and the mother/birth parent conceived the child through assisted reproduction. Do I need a notary or a witness? Yes. Each parent must choose to sign the AOP in front of either a notary OR a witness. The notary or witness must also complete the signature block. Common notary locations include hospitals, local banks, title companies, and attorneys/county clerks. A person signing the witnessed statement must be at least 18 years of age and not related by blood or marriage to the individuals who sign an AOP form. The local child support offices will serve as witnesses. Center for Health Statistics staff will not serve as witnesses. How do I change my child’s last name? You have 1 year from the date the AOP is filed to submit an Affidavit for Correction form to change your child’s last name. You can change it to either parents’ name on the AOP, any combination of either parents’ last names, or hyphenated. You can only make this change once. Both parents listed on the AOP must sign the form. You can send the Affidavit for Correction form separately or together with an AOP form to the Department of Health. There is no additional fee. If the child is 18 years or older, a court order is required to change the child’s name.

Center for Health Statistics P.O. Box 9709 Olympia, WA 98507 360-236-4300 Fees: $18 Filing Fee $20 Birth Certificate THIS IS A LEGAL DOCUMENT

Page 4 of 4

DOH 422-159 April 2019

Denying Parentage Checkbox Only check this box if another person is denying parentage. If checked, the person denying parentage must submit a Denial of Parentage form (DOP). The form can be signed by:

The spouse or ex-spouse who is or was married to the birth parent/mother and will not be the parent listed on the child’s birth certificate.

A person who is genetically related to the child and is revoking their right to be a parent listed on the child’s birth certificate.

The second parent listed on the child’s birth certificate. An AOP form must be submitted to replace the second parent being removed.

The AOP and DOP can be filed separately or at the same time, but neither is valid unless both are filed with the Department of Health, Center for Health Statistics. If you choose to send the forms together, only one non-refundable filing fee of $18 is required. Otherwise, two non-refundable $18 filing fees are required. Definitions

“Alleged genetic parent” means an individual who is alleged to be, or alleges that the individual is, a genetic parent

or possible genetic parent of a child whose parentage has not been adjudicated. The term includes an alleged

genetic father and alleged genetic mother (RCW 26.26A.010(3)).

“Assisted reproduction” means a method of causing pregnancy other than sexual intercourse (RCW 26.26A.010(4)).

“Intended parents” means an individual, married or unmarried, who manifests an intent to be legally bound as a

parent of a child conceived by assisted reproduction (RCW 26.26A.010(13)).

“Presumed parent” means an individual who is presumed to be a parent of a child, unless the presumption is

overcome in a judicial proceeding, a valid denial of parentage, or a court adjudicates the individual to be a parent

(RCW 26.26A.010(17)). A person is presumed to be the parent of the child if:

o The individual and birth parent were married to or in a state registered domestic partnership with each other and the child was born during the marriage or partnership; or

o The individual and birth parent were married or in a state registered domestic partnership with each other and the child is born within 300 days after the marriage is terminated by death, annulment, divorce, dissolution or declaration of invalidity; or

o The individual and birth parent were married or entered into a state registered domestic partnership with each other after the birth of the child and filed an assertion with the Department of Health; or

o The individual and birth parent were married or entered into a state registered domestic partnership with each other after the birth of the child and agreed to be named as a parent of the child on the birth certificate; or

o The individual seeking to establish parentage resided in the same household with the child for the first four years of life of the child, including any period of temporary absence, and openly held out the child as the individual’s child (RCW 26.26A.115).

“Witnessed” means at least one individual who is authorized to sign has signed a record to verify that the individual personally observed a signatory sign the record (RCW 26.26A.010(23)). A third party person signing the witnessed statement must be at least 18 years of age and not related by blood or marriage to the individuals who sign a voluntary acknowledgment of parentage, denial of parentage, or rescission of parentage form.

“Notarial officer” means a notary public or other individual authorized to perform a notarial act (RCW 42.42.010(9)). If you need help understanding your rights and responsibilities as parents and the alternatives to, and consequences of, signing this form, call the Division of Child Support at 1-800-442-5437.

DOH 422 -163 January 2019

Washington State Department of Health

Parentage Verification Order Form

Inst

ruct

ion

s

Print clearly.

We only accept checks or money orders for mail orders. Do not send cash or credit card information.

$15 per verification.

All requests require a copy of the requestors ID (must be the signatory of the requested original document).

Only the signatories of the Acknowledgment of Parentage form may request a Parentage Verification Letter (also known

as CBRI letter).

Visit www.doh.wa.gov for more information and ordering options or call 360-236-4300, Monday through Friday

between 8:30 a.m. and 5 p.m. Pacific Time.

Co

nta

ct

Info

rm

ati

on

Name of person ordering verification(s):

Address sending verification(s) to:

(Street address required for FedEx orders)

City: State: ZIP Code:

Daytime Phone: (______) ______________________ Email Address:

Complete ALL fields below with exact and complete information. This required information must match current information on the birth record.

Full Name on Certificate: (First Name) (Full Middle Name) (Last Name)

Date of Birth: (MM/DD/YYYY) City or County of Birth:

Mother/Parent Birth Name: (First Name) (Full Middle Name) (Last Name Prior to First Marriage)

Father/Parent Birth Name: (First Name) (Full Middle Name) (Last Name Prior to First Marriage) Not

Listed

*** All requests require a copy of the requestors ID (must be the signatory of the requested original document) ***

Complete payment and mailing information below:

Total number of CBRI Letters: ________ x $15 = $ _______

Total number of filed Assertion of Parentage form copies: ________ x $15 = $ _______

Total number of filed Denial of Parentage form copies: ________ x $15 = $ _______

Total number of filed Acknowledgment of Parentage form copies: _____ x $15 = $ _______

Total number of filed Rescission of Parentage form copies: ________ x $15 = $ _______

Apostille:______________(name of country requesting document) : ________ x $15 = $ _______

Total number of certified Birth Certificates : ________ x $20 = $ _______

First Class Mail No additional charge

*USPS Express Mail Delivery (street address or P.O. Box) $18.30 = $ _______

*FedEx to continental US (no P.O. Box) $15 = $ _______

*FedEx to AK/HI/Canada/Mexico (no P.O. Box) $25 = $ _______

TOTAL AMOUNT DUE $ _______

*Additional charges for express delivery are per order, not per certificate.

*Adult Signature is required at time of delivery for USPS Express Mail & FedEx orders.

Make checks or money

orders payable to DOH.

MAIL ORDERS TO:

Department of Health

P.O. Box 9709

Olympia, WA 98507-9709