ACKNOWLEDGMENT OF PATERNITY (AOP) Budget: ZZ712
INQUIRY REQUEST FORM Fee Received: ______
___ Positive Search
___ Negative Search
Date Mailed/ Fax: _______
The AOP Registry only includes Acknowledgments of Paternity filed from September 1,
1999 to the present.
Name of Child: ________________________________________ Date of Birth:_______
City or County of Birth: ________________________________
Mother’s complete name: _______________________________ Date of Birth:________
Biological Father’s name: _______________________________ Date of Birth:________
Check One: Certified Copy of AOP Certified Copy of AOP Rescission
Name and address of Person making the Inquiry:
First Middle Last
Address City State Zip Code
( ) ( )
Daytime Telephone Number Fax number
Family Code §160.313 allows access to AOP’s to the following individuals/agencies:
Relationship: ___ Mother ___ Father ___ Presumed Father ___Court Ordered for Attorney
Release: I authorize you to give the copy of the above-identified Acknowledgment of Paternity form or Rescission of
Acknowledgment of Paternity form to:
_____________________________________________________________________________
___________________________________________ ______________
SIGNATURE OF REQUESTOR DATE
This inquiry request requires a search fee. If paying by credit card, the fee is $12.25. If paying by check or money
order, the fee is $10.00. Make check or money order payable to Texas Department of State Health Services
(DSHS) -ZZ712. Mail completed form and fee to the address below. This inquiry may also be faxed to 512-776-
7164 and paid with a MasterCard, Visa, Discover, or American Express.
If faxed: ___M/C ___VISA ___DISCOVER CARD # ______________________________________ EXP DATE ________________
___American Express
NAME OF CARDHOLDER __________________________________________________
Mail To: CARDHOLDER ADDRESS__________________________________________________
AOP Registry
Vital Statistics Unit, MC 1966 _________________________________________
P.O. BOX 12040
Austin, Texas 78711-2040 3 - DIGIT SECURITY CODE _______________(Found on back of card)
CARDHOLDER PHONE NUMBER,
INCLUDING AREA CODE ____________________
_______________________________
***IMPORTANT: A copy of government-issued photo identification must be provided
with this request [25 TAC §181.1(13)] ***
VS-134.1 Rev 06/2015
***CHILD'S NAME AS IT APPEARS ON THE ORIGINAL BIRTH CERTIFICATE***
***Identification is required for all credit card payments, if name listed on credit card is different
from requestor.***
