Fill - Free fillable Minnesota Voluntary Recognition of Parentage PDF form

DHS-3159-ENG 5-18

Minnesota Voluntary Recognition of Parentage

Purpose

Signing and filing this Recognition of Parentage (ROP) form establishes a legal relationship between a father and

child when the biological father is not married to the child's mother. Signing and filing this form:

• Legally establishes the biological father's paternity

• Creates and waives certain rights and responsibilities for the mother, father and child

• Allows the father's name to be on the child's birth record

• Provides a basis for establishing child support

• Does not establish custody or parenting time.

Instructions for parents

Get answers to your questions before you sign this form. Signing this form is voluntary. If, you are unsure who the

biological father is, you should not sign this document and you should have a genetic test. To obtain a genetic test,

contact your county child support office or seek genetic testing services on your own. A Recognition of Parentage can

be revoked by either parent if a written revocation signed by that parent in front of a notary public is filed with the

Minnesota Department of Health, Office of Vital Records within 60 days after the Recognition of Parentage is signed.

After 60 days, a fully executed and filed Recognition of Parentage has the same force and effect as a court order

establishing paternity. Upon filing, the Department of Health will update the birth record with the father's name.

If you want to voluntarily establish the legal relationship between a father and child when the father is not married

to the child's mother:

• Read all four pages of this form and the booklet Being a Legal Father: Parentage information for mothers and

fathers (DHS-3159A) carefully or have someone read them to you

• Watch the paternity establishment video

• If the mother was married to a person other than the child's biological father, the mother's spouse must also sign

and submit a Spouse's Non-Parentage Statement and file with the Minnesota Department of Health

• Fill out all of this form with information that matches your child's birth record

• Ask for a new form if you make a mistake. Do not cross out words, leave blanks or make corrections

• Sign this form in front of a notary public

• File this completed form with the Minnesota Department of Health.

When you sign this form, you may also change your child's last name from what is on your child's birth record. If

you want to change the last name and both parents agree, write your child's new last name in the designated box. If

you do not want to change the last name or if your child's birth record is not filed yet, write your child's current last

name in the box.

Instructions for assisting agencies

• Provide verbal notice to the parents of their rights, responsibilities and their alternatives to signing this

Recognition of Parentage.

• Complete the Agency section on the bottom of the completed Recognition of Parentage by checking a box and

writing the name of the agency where the form is completed.

• Fax or send the form to the Minnesota Department of Health.

• Give each parent a copy of the form and keep the original or a copy for your records.

• Follow your agency's policies and procedures for contacting the parents to sign and file a new form if you

become aware that the form is rejected by the Minnesota Department of Health.

Fax this completed form to 651-215-5834.

If you are unable to fax this form, mail it to:

Minnesota Department of Health

Office of Vital Records

P.O. Box 64499

St. Paul, MN 55164-0499

For accessible formats of this publication or

assistance with additional equal access to

human services, write to DHS.Info@state.mn.us,

call 651-431-4400, or use your preferred relay

service. (ADA1 [9-15])

DHS-3159-ENG 5-18

MINNESOTA DEPARTMENT OF HUMAN SERVICES

Minnesota Voluntary Recognition of Parentage

CHILD

FIRST NAME MIDDLE NAME LAST NAME SUFFIX (Jr., Sr., I, II, etc.)

DATE OF BIRTH BIRTH PLACE (city/state)

Do you want to change your child's last name?

Yes No

If yes, write the new last name in the box to the right.

If no, write the current last name in the box to the right.

CHILD'S LAST NAME

MOTHER

FIRST NAME MIDDLE NAME LAST NAME SUFFIX DATE OF BIRTH (mm/dd/yyyy)

BIRTH PLACE (city/state) SOCIAL SECURITY NUMBER PHONE NUMBER (optional)

MAILING ADDRESS CITY STATE ZIP CODE

Were you married to a person other than the biological father when this child was conceived or born?

Yes No If yes, the spouse/ex-spouse must also file a Spouse's Non-parentage Statement (Form DHS-3159C) within one

year of this child's birth to put the name of the biological father on this child's birth record.

FATHER

FIRST NAME MIDDLE NAME LAST NAME SUFFIX DATE OF BIRTH (mm/dd/yyyy)

BIRTH PLACE (city/state) SOCIAL SECURITY NUMBER PHONE NUMBER (optional)

MAILING ADDRESS CITY STATE ZIP CODE

By signing this Recognition of Parentage, I swear or affirm all the following:

• I am the biological parent of the child named above.

• The rights, responsibilities, alternatives and legal consequences

associated with signing this form as outlined in the Parent's

statement, Waiver of rights and Custody and parenting time

information sections of this form have been explained to me

verbally and/or in writing and I understand and accept them

• To the best of my knowledge, all of the above information is true

and correct.

• I understand that I have the right to genetic tests. If I have not had

genetic testing, I am certain that the father listed above is the

biological father of the child.

• I understand that signing this form does not establish custody or

parenting time and the mother has sole custody until a court

orders otherwise.

• I understand that signing this form allows the court to order

child support.

• I am voluntarily signing this form for the purpose of establishing

paternity for my child and making sure both parents are listed on

my child's birth record.

• I understand that I have the right to revoke this Recognition of

Parentage within 60 days. I understand that I may revoke the

Recognition of Parentage by signing a written revocation in front

of a notary public and filing it with the Minnesota Department of

Health, Office of Vital Records. I understand that if the

Recognition of Parentage is not revoked within 60 days, it has

the same force and effect as a court order establishing paternity

and would take a court order to undo.

Mother's signature x_______________________________ Biological father's signature x_______________________

NOTARY PUBLIC

In the state of _________________, County of______________________

NOTARY STAMP

Signed and sworn/affirmed to before me this (mm/dd/yy):

/ /

__________________________________

Notary Public Signature

______________________

My commission expires

In the state of _________________, County of______________________

NOTARY STAMP

Signed and sworn/affirmed to before me this (mm/dd/yy):

/ /

__________________________________

Notary Public Signature

______________________

My commission expires

AGENCY

Form completed at:

MDH DHS County Hospital

Other

(agency name)

DHS-3159-ENG 5-18

Clear Form

Parent's statement

I swear/affirm that:

• I have been told about the Recognition of Parentage

form and understand my rights and responsibilities

created and waived by signing this form.

• I have a copy of Being a Legal Father: Parentage

information for mothers and fathers (DHS-3159A). I

read the booklet or had someone else read it to me.

• I have received additional oral notice about my rights,

responsibilities and alternatives to signing this form,

and/or had the opportunity the view the paternity

establishment video which is available online and at

all county child support offices.

• I understand that either of us may choose not to

acknowledge paternity. As alternatives to signing the

Recognition of Parentage, either of us could ask the

court to decide on paternity or we could acknowledge

paternity later.

• I acknowledge that we are the biological parents of the

child named in this Recognition of Parentage.

• I understand that this Recognition of Parentage

does not give custody or parenting time to the legal

father. However, this Recognition of Parentage gives

the father the right to ask the court for temporary or

permanent custody and/or parenting time.

• If I sign this Recognition of Parentage and pursue a

court order for custody, I understand that under

Minnesota Statutes Chapter 518, there is no

presumption for or against joint physical custody

except in cases involving domestic abuse between the

parents.

• I understand that either of us can take legal action to

establish paternity instead of signing the Recognition

of Parentage and that either of us may apply for

paternity establishment services at our local child

support office.

• I understand that either of us can choose to have

genetic testing done before we sign the Recognition of

Parentage.

• I accept responsibility to provide financial child

support for my child. I understand that a court can

order financial child support that can include

payments for basic, medical and child care support

going back to the date of my child's birth or two years

from the start of a legal action, whichever is earlier,

and continuing until a court order for support ends.

• I understand that financial support can also include

the following: reimbursement of public assistance

furnished for the benefit of my child, reimbursement

of the pregnancy and confinement expenses

associated with my child's birth, reimbursement of

any genetic testing fees paid by the public authority.

• I understand that both parents have the right to all

notices of any adoption proceedings.

• I understand that this is a legal document. If we are

both age 18 or older when we sign this form, this

Recognition of Parentage is the same as a court order

determining the legal relationship between a father

and child.

• I understand that if either of us is under age 18 when

we sign this form, this Recognition of Parentage is only

a presumption of paternity. It is not final. I understand

that I have six months after the youngest of us turns 18

to take legal action to declare the nonexistence of the

father and child relationship.

• I understand that either of us can cancel this

Recognition of Parentage by stating in writing that, "I

am revoking the Recognition of Parentage." I

understand that I must sign the revocation in front of a

notary public and that I must file the revocation with

the Office of Vital Records within 60 days after I sign

this form. If I have not filed a revocation within 60

days, I understand that this Recognition of Parentage

will have the same force and effect as a court order

establishing paternity. If I still want to cancel this

Recognition of Parentage after the 60 days, I

understand that I will need to take legal action to

request that the court change any of the information in

this Recognition of Parentage which the court may or

may not do.

• I understand that this Recognition of Parentage will

not be considered valid if the mother of the child was

married to another person at the time this child was

conceived or born unless this Recognition of Parentage

is filed in conjunction with a Spouse's Non-parentage

Statement.

• To the best of my knowledge, the information on this

form is true.

• I am signing this form voluntarily. No one forced me

to sign this Recognition of Parentage.

Waiver of rights

By signing this Minnesota Voluntary ROP form

(DHS-3159), you give up the right to:

• Participate in a paternity proceeding, where an

attorney could represent me

• A trial to determine if the man is the biological father

of the child

• Cross-examine witnesses in a paternity proceeding

• Testify about who is the biological father of the child in

a paternity proceeding.

Custody and parenting time information

When a child is born to parents who are not married to

each other the law gives custody of the child to the

mother. If either parent wants a different custody

arrangement, the parents must go to court.

Please contact an attorney if there are any questions.

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