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
Page 2 of 2 OFFICE OF VITAL RECORDS 06/2020
Application for a Certified Copy of a Recognition of Parentage,
Spouse’s Non-parentage Statement or Revocation Form
Name of the person requesting the certifed copy (copies over from page one)
How many certified copies do you want? Fee Copy cost
One certified copy of a filed Recognition of Parentage or other paternity form costs $9 $9 $9
How many additional certified copies do you want?
# of additional copies
$9 each
How do you want your request processed? Fee
Processing cost
Standard request processed in the order received $0
Faster your request goes ahead of standard requests (Does not include UPS delivery) $20
How do you want the your order delivered to you? Fee
Delivery cost
Regular First Class Mail® $0
United Parcel Service (UPS) $16
For UPS delivery, check here to require a signature.
The Office of Vital Records and UPS are not responsible for deliveries that do not require a signature.
UPS will not deliver to PO boxes or APO addresses.
If you want UPS delivery to an address outside of the United States, you must include a UPS prepaid envelope
when you submit your application and fees.
Fees are due with the application and are non-refundable.
Minnesota Statutes, section 144.226
Amount due =
Copy + Processing + Delivery costs
The Office of Vital Records returns applications that are incomplete, not signed in
front of a notary public, or not paid in full at the time of application.
Amount must be at least $9
How do you want to pay for your order?
Credit card
MasterCard/Visa/Discover
Cardholder name Valid thru
Card number 3-digit security code
Check
Check # _____________________
Money order
Money order number_____________________
Make check or money order payable to the Minnesota Department of
Health and send by mail with the application. DO NOT SEND CASH.
Checks returned for non-payment will result in a $30 charge to you. You
could also face civil penalties.
Minnesota Statutes, section 604.113, subdivision 2.
If you have questions about how to get a certified copy of a filed Recognition of Parentage or other paternity form,
contact health.vitalrecords@state.mn.us
or 651-201-5970.
Send application and payment to the Office of Vital Records
Mail application and check, money order or credit card information to:
Minnesota Department of Health
Office of Vital Records
PO BOX 64499
St. Paul, MN 55164-0499
Fax application with credit card information to:
651-201-5740
Do not email your application.
Do not send cash.