Page 1 of 2 OFFICE OF VITAL RECORDS 06/2020
Application for Certified Copy of a Recognition of Parentage,
Spouse’s Non-parentage Statement or Revocation Form
Complete this application to request a certified copy of a Recognition of Parentage (ROP), Declaration of Parentage
(DOP), Spouse's Non-parentage Statement (SNPS), or Husband's Non-paternity Statement (HNPS), or the respective
revocation forms filed with the Office of Vital Records. You must be eligible under law to get a certified copy of a form.
It is against the law to provide false information to obtain a certified vital record. You may be subject to fines, jail time or both.
Information on child's birth record
Child's first name Child's middle name Child's last name
Child's date of birth
(MM/DD/YYYY)
Child's place of birth
Sex
☐ Female
☐ Male
Birth Certificate State File Number
(if known)
Mother/Parent 1 first name Mother/Parent 1 middle name Mother/Parent 1 maiden name
Father/Parent 2 first name
Father/Parent 2 middle name Father/Parent 2 last name
Spouse's first name
Spouse's middle name Spouse's last name
I want a certified copy of:
A certified copy is available to the person who signed or is named on the form, or as authorized by law:
☐
Recognition of Parentage or Declaration of Parentage
☐
Spouse’s Non-parentage Statement or Husband’s Non-paternity Statement
☐
Revocation of a Recognition of Parentage or revocation of a Spouse’s Non-parentage Statement
Information about you – the person requesting the certified copy
Your name Email address Daytime phone (10-digit)
Mailing address - street Apt/unit #
City State ZIP Code
What is your relationship on the paternity form? You must check one below.
☐ I signed the Recognition of Parentage, Declaration of Parentage, Spouse’s Non-parentage Statement, or Revocation form and
my name appears on the form.
☐ I am the child and my name appears on the birth record and the Recognition of Parentage or Declaration of Parentage form.
☐ I am a representative of a Minnesota state, local, or tribal government office and have access to data about births for child
support enforcement and other purposes allowed under Minnesota Statutes, section 144.225, subdivision 2.
1. Provide the name of your government office. 2. Sign your name below.
Notary not required.
3. Include a copy of your employee ID with this
request.
If you are a child support representative for an office outside of Minnesota, contact the Minnesota Department of Human Services
at 651-431-4400 for help getting the copy you want. Or, have a parent who signed the parentage/paternity form make the request.
Sign this form in front of a Notary Public
I certify that the information provided on this application is accurate and complete to the best of my knowledge.
Requester’s printed name Notary stamp / seal
Requester’s signature
Signed or attested before me on: _ day of _________ , 20 ___
Notary public printed name
Notary public signature My commission expires
