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The Arizona Paternity form, officially known as the Acknowledgment of Paternity (CS-127), serves a critical role in establishing legal fatherhood for children born out of wedlock. This form is designed to ensure that both parents recognize their responsibilities and rights regarding their child. It is essential to understand that this acknowledgment is not applicable if the mother was married at the time of the child's birth or during the ten months preceding it, unless accompanied by a Waiver of Paternity Affidavit. Completing the form requires careful attention to detail, including the use of black ink and the necessity for all fields to be filled out completely to avoid delays in processing. Each parent's signature must be witnessed or notarized, reinforcing the legal weight of the document. In cases of multiple births, individual forms for each child must be submitted. This acknowledgment not only affirms paternity but also entitles the child to various benefits, including financial support and access to medical histories from both parents. Understanding the implications of signing this form is crucial, as it legally establishes paternity and carries with it the responsibilities that come with parenthood. Furthermore, parents have the right to rescind the acknowledgment within a specified period, ensuring that the decision is made without coercion. Overall, the Arizona Paternity form is a vital legal instrument that facilitates the recognition of a child's right to know and benefit from both parents.

Sample - Arizona Paternity Form

CS-127 (11-17)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Division of Child Support Services
ACKNOWLEDGMENT OF PATERNITY
READ ALL INSTRUCTIONS CAREFULLY AND REMOVE THIS PAGE BEFORE COMPLETION
The purpose of this form is to acknowledge paternity for a child born out of wedlock.
This Acknowledgment of Paternity IS NOT applicable if the mother of the child was married at the time of birth or was
married at any time in the ten months immediately preceding such birth pursuant to A.R.S. § 25-814, unless accompanied
by a Waiver of Paternity Afdavit.
COMPLETION
• Read the “Acknowledgment of Paternity” (CS-127) and the Notice of Alternatives, The legal Consequences and the
Rights and Responsibilities.
• Only use BLACK INK. Colored inks ARE NOT ACCEPTABLE. Type or print all required information except where sig-
natures are required. The Spanish translation on the last page is for reference only. Please complete the English side.
• DO NOT MAKE CORRECTIONS ON THE FORM. Forms with crossouts, erasures, alterations, etc., will invalidate
the Acknowledgment. DO NOT SUBMIT AN ACKNOWLEDGMENT CONTAINING SUCH CHANGES. If you make a
mistake, ask for a new form and begin again.
• Fill in every blank or box on the form. Incomplete or incorrect information may cause delays in the ling of the
Acknowledgment.
• In cases of multiple births, a separate Acknowledgment for each child must be completed.
• The Acknowledgment must be signed in the presence of a Witness or Notary Public. Each parent must sign
their name on all copies of the form and each signature must be witnessed or notarized. Each parent must show the
Witness or Notary appropriate, valid identication. The parents should use their legal name only. Nicknames, short-
ened name, etc., SHOULD NOT be used. Your Legal Name is the one that appears on your birth certicate, or other
ofcial documents.
• If both parents cannot sign the Acknowledgment at the same time, use a separate Acknowledgment. When signing
separate Acknowledgments the child’s information should be identical on each form. All blanks must be completed
and both Acknowledgments submitted together.
• If you are changing the child’s name, after 3 months of age only the last name of the child can be changed using
this form. Any other changes must be requested through the Ofce of Vital Records.
• If completing this Acknowledgment away from the hospital, remember to sign in the presence of a Notary Public
or qualied Witness. A qualied Witness must be at least 18 years old and not related to either parent by blood or
marriage. Notary Publics are listed in the telephone directory. RETURN ALL PAGES (excluding completion instruc-
tions) OF THE ACKNOWLEDGMENT. Mail the entire document to:
DCSS Hospital Paternity Program – HPP
PO BOX 64533
Phoenix, AZ 85082
• If you require a copy of the birth certicate, mail your application monies, along with the birth certicate application, to
the address listed on the birth certicate application. DO NOT mail any monies to the Hospital Paternity Program.
DEFINITIONS
DES - Department of Economic Security
DHS - Department of Health Services
DCSS - Division of Child Support Services
HOW WILL YOUR CHILD BENEFIT IF YOU SIGN THIS FORM?
• Every child has the right to know his or her mother and father and benet from a relationship with both parents.
• Your child will have two legal parents.
• Your child has a right to nancial support from both parents.
• It will be easier for your child to learn the medical histories of both parents and to benet from health care coverage
available to you.
• It will be easier for your child to inherit through you and receive benets such as dependent or survivor’s benets from
Veterans Affairs or the Social Security Administration
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the
Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of
1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination
in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, dis-
ability, genetics and retaliation. To request this document in alternative format or for further information about this policy,
contact 602-252-4045; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request.
Ayuda gratuita con traducciones relacionadas con los servicios del DES esta disponible a solicitud del cliente.
GO TO FORM
En Español
CS-127 (11-17) Page 2
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
ACKNOWLEDGMENT OF PATERNITY
NO.
PLEASE PRINT CLEARLY. Complete in BLACK INK. DO NOT ALTER, LEGAL DOCUMENT
CHILD’S INFORMATION
CHILD’S NAME (First, Middle, Last, Sufx) AS IT
APPEARS ON THE BIRTH CERTIFICATE
BIRTHDATE (MM/DD/YY)
MALE
FEMALE
PLACE OF BIRTH
CITY
COUNTY
STATE
HOSPITAL
HOW YOU WANT THE CHILD’S NAME TO APPEAR ON THE BIRTH CERTIFICATE
IF THE CHILD’S NAME HAS NOT CHANGED, PLEASE PRINT THE CHILD’S NAME AS IT APPEARS ON THE ORIGINAL BIRTH CERTIFICATE
FIRST
MIDDLE
LAST
SUFFIX (Jr., II)
MOTHER’S INFORMATION
FIRST NAME
MIDDLE NAME
LAST NAME
MAIDEN NAME
BIRTHDATE (MM/DD/YYYY)
SOC. SEC. NO.
AREA CODE AND PHONE NO.
PLACE OF BIRTH (City, State)
COUNTRY OF BIRTH
ADDRESS: (Street, Apt. No., City, State, ZIP)
EMPLOYER
OCCUPATION
FATHER’S INFORMATION
FIRST NAME
MIDDLE NAME
LAST NAME
BIRTHDATE (MM/DD/YYYY)
SOC. SEC. NO.
AREA CODE AND PHONE NO.
PLACE OF BIRTH (City, State)
COUNTRY OF BIRTH
ADDRESS: (Street, Apt. No., City, State, ZIP)
EMPLOYER
OCCUPATION
The mother was legally married at the time of conception and/or birth of the child.
A court order or decree of dissolution which rebuts paternity is attached.
A Waiver of Paternity Afdavit completed by
the present/former husband is attached.
This Acknowledgment is being signed voluntarily with no threat or harm or duress. I have received written and oral notice and
have read the NOTICE OF ALTERNATIVES, THE LEGAL CONSEQUENCES AND RIGHTS AND RESPONSIBILITIES. I understand
my alternatives, the legal consequences and the rights and responsibilities. I swear and afrm under penalty of perjury
pursuant to A.R.S. §13-2702 that this application and any accompanying documents have been examined by me and to the
best of my knowledge and belief are true and correct.
SIGNATURE OF MOTHER (Sign only in presence of Witness) DATE
(MM/DD/YY
SIGNATURE OF WITNESS (TO BE COMPLETED BY THE [Check one]:
HOSPITAL GOVERNMENT AGENCY OTHER)
SIGNATURE OF FATHER (Sign only in presence of Witness)
DATE (MM/DD/YY)
SIGNATURE OF WITNESS (TO BE COMPLETED BY THE [Check one]:
HOSPITAL GOVERNMENT AGENCY OTHER)
WITNESS MUST BE AT LEAST 18 YEARS OF AGE AND NOT RELATED BY BLOOD OR MARRIAGE.
PRINTED NAME OF WITNESS
ADDRESS
ADDRESS
PRINTED NAME OF WITNESS
ADDRESS
ADDRESS
------------------------------------------------------------------- NOTARY SECTION ------------------------------------------------------------------
TO BE COMPLETED BY A NOTARY PUBLIC ONLY IF NOT WITNESSED ABOVE
State of Arizona, County of
Subscribed and sworn or afrmed before me
this
day of
,
NOTARY PUBLIC
PLACE NOTARY SEAL HERE
My Commission expires
State of Arizona, County of
Subscribed and sworn or afrmed before me
this
day of
,
NOTARY PUBLIC
PLACE NOTARY SEAL HERE
My Commission expires
Check this box if form completed at the hospital.
ALL COPIES OF THIS DOCUMENT MUST HAVE ORIGINAL SIGNATURES
Paternity Date
For Ofce Use Only
THIS ACKNOWLEDGMENT IS BEING SIGNED VOLUNTARILY WITH NO THREAT OR HARM OR DURESS
*B*
Clear the Form
Formulario en Español
CS-127 (11-17) Page 3
NOTICE OF ALTERNATIVES, THE LEGAL CONSEQUENCES
AND RIGHTS AND RESPONSIBILITIES
PLEASE READ THIS INFORMATION CAREFULLY BEFORE YOU SIGN THE FORM
The purpose of this form is to acknowledge paternity for a child born out of wedlock.
We, the natural mother and natural father, declare that the information provided is true and correct. We acknowledge that
the father named is the only possible father of the child named.
If the mother was married at any time in the ten months immediately preceding the birth or the child is born within ten
months after the marriage is terminated by death, annulment, declaration of invalidity or dissolution of marriage or after
the court enters a decree of legal separation, a Waiver of Paternity Af
davit must accompany this document pursuant to
A.R.S. § 25-814.
I understand that if the current/former husband’s location is unknown to the mother, the mother will be required to apply for
IV-D Services and The Division of Child Support Services will attempt to locate the current/former husband.
I understand that by signing this acknowledgment we are giving up our right to a court hearing to determine paternity as
well as the right to have genetic testing done to determine the parentage of this child.
I further understand we may have a right to rescind or challenge this acknowledgment as outlined in A.R.S. § 25-812.
I understand the signing of this acknowledgment will result in the legal determination of paternity.
I understand that upon the determination of paternity, both parents have a legal obligation to support their child pursuant
to A.R.S. § 25-501 as well as other duties imposed by Arizona law.
I understand this paternity determination is not a custody order but provides a basis for determining issues related to cus-
tody and visitation and affords the parents all rights and responsibilities provided by Arizona law.
I understand that either parent has a right to cancel the Acknowledgment of Paternity by completing an Afdavit of Paterni-
ty Rescission within 60 days from the date of the last witnessed/notarized signature on the Acknowledgment and sending
it to the Hospital Paternity Program pursuant to A.R.S. § 25-812. I have read the information provided and received oral
notication of our rights and responsibilities by either speaking to staff, viewing a paternity video or phoning 1-800-485-
6908.
A voluntary Acknowledgment of Paternity led with The Department of Economic Security or The Department of
Health Services has the same force and effect as a Superior Court judgment pursuant to A.R.S. § 25-812.
I further declare this statement to be made for recording with the Clerk of the Superior Court, the Department of Economic
Security or the Department of Health Services pursuant to A.R.S. § 25-812 and hereby consent and request that the birth
certicate be amended to show the father’s name and to show the child’s name as requested on the front of the Acknowl-
edgment of Paternity. Please note: Any questions regarding name changes should be directed to the Arizona Department
of Health Services, Ofce of Vital Records at (602) 364-1300.
I understand that if it is deemed appropriate by DES, this acknowledgment may be used to obtain a paternity order in any
Arizona county having venue.
I understand that I am required to provide my Social Security Number pursuant to 42 USC § 652(a)(7) and 666(a)(5)(IV).
DES/DCSS will use this information to establish paternity and if appropriate, to establish and enforce a child support order.
I swear or afrm under penalty of perjury pursuant to A.R.S. § 13-2702 that this application and/or accompanying docu-
ments have been examined by me and to the best of my knowledge and belief are true and correct.
WHAT DOES IT MEAN IF YOU SIGN THIS FORM?
By signing this Acknowledgment of Paternity you are legally establishing your child’s paternity. Paternity means legal
fatherhood.
Signing this form is voluntary. You should not sign this form if you have been threatened or coerced.
This Acknowledgment does not automatically give the father visitation or custody rights, but he may use it to ask the Court
for them.
Either parent can rescind this form within 60 days of the last signature on the form by signing an Afdavit of Paternity Re-
scission (CS-258). To request an Afdavit of Paternity Rescission, contact the Hospital Paternity Program at
1-800-485-6908.
CS-127 (11-17) Page 4
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Ofce of Vital Records
ADDITIONAL INFORMATION REGARDING THE FATHER LISTED ON
THE ACKNOWLEDGMENT OF PATERNITY
(for birth certicate processing purposes)
The Arizona Department of Health Services’ Ofce of Vital Records is required to collect and report data to the Department of Health
and Human Services’ National Center for Health Statistics (NCHS). Please complete the data below in order to capture this information
for statistical purposes. Thank you in advance for completing this information.
CHILD’S NAME (First, Middle, Last, Sufx) BIRTHDATE
MOTHER’S NAME (Last, First, M.I.)
FATHER’S NAME (Last, First, M.I.)
FATHER’S EDUCATION (Check One)
What is the highest level of schooling you will have completed at the time of the child’s delivery? Check one of the following boxes that
best describes your education. If you are currently enrolled, check the box that indicates the previous grade or highest degree received.
8th grade or less
9th – 12th grade, no diploma
High school graduate or GED completed
Some college credit, but no degree
Associate degree (e.g. AA, AS )
Bachelor’s degree (e.g. BA, AB, BS )
Master’s degree (e.g. MA, MS MEng, Med, MSW, MBA )
Doctorate degree (e.g. PhD, EdD) or
Professional degree (e.g. MD, DDS, DVM, LLB, JD )
FATHER’S RACE (Check All That Apply)
White
Black, African American
American Indian or Alaska Native (*see list below)
Primary or Enrolled tribe:
Additional Tribe:
Additional Tribe:
Additional Tribe:
Asian Indian
Chinese
Filipino
Japanese
Korean
Other Asian
Specify:
Specify:
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacic Islander
Specify:
Specify:
Other
Specify:
Specify:
Unknown Refused Not Obtainable
*Please select the appropriate Arizona tribe(s) the father is afliated with from the list provided below and print the tribe name in the
space(s) provided above. If the father is afliated with a non-Arizona tribe, please write “other” in the space provided or print the name
of the non-Arizona tribe.
Ak Chin Indian Community Navajo Tribe
Camp Verde Yavapai Apache Pascua Yaqui
Cocopah Tribe Prescott Yavapai Indian Community Quechan Tribe
Colorado River Indian Tribes Salt River Indian Community (Pima)
Fort Mohave Tribe San Carlos Apache Tribe
Ft. McDowell Mohave-Apache Community Gila River Indian Community San Juan Southern Paiute Band
(Pima) Havasupai Tribe Tohono O’Odham Tribe (Papago)
Hopi Tribe Tonto Apache
Hualapai Tribe White Mountain Apache Tribe (Fort Apache)
Kaibab Band of Paiute Indian
FATHER’S HISPANIC ORIGIN (Check One)
No, not Spanish, Hispanic or Latino
Yes, Mexican, Mexican American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, other Spanish/Hispanic/Latina (e.g. Spaniard, Salvadoran,
Dominican, Columbian)
Specify:
Specify:
Unknown Refused Not Obtainable
CS-127 (11-17) Page 5
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Division of Child Support Services (División de Servicio de Sustento para Menores)
RECONOCIMIENTO DE PATERNIDAD
LEA DETENIDAMENTE TODAS LAS INSTRUCCIONES Y DESPRENDA ESTA HOJA ANTES DE LLENAR EL FORMULARIO
El propósito de este formulario es reconocer paternidad para un niño nacido a una madre soltera. Conforme a A.R.S. §25-814(b), este
Reconocimiento de Paternidad NO ES aplicable si la madre del niño estuvo casada cuando nació el niño o en cualquier momento
durante los diez meses inmediatamente anteriores al nacimiento del niño, salvo que cuando esté acompañado por una Renuncia de
Adávit de Paternidad.
PARA LLENAR EL FORMULARIO
• Lea el “Reconocimiento de Paternidad” (CS-127) y el Aviso de Alternativos, “las Consecuencias legales” y “los Derechos y Res-
ponsabilidades’
• Use sólo TINTA NEGRA. NO SE ACEPTARÁ tintas en colores. Escriba a máquina o con letra de molde toda la información reque-
rida excepto donde haya que rmar. La traducción al español en la última página es sólo para referencia; sírvase llenar el lado en
inglés.
• NO HAGA CORRECCIONES EN EL FORMULARIO. Formularios con tachones, borraduras, alteraciones etc. invalidarán el Reco-
nocimiento. NO PRESENTE UN RECONOCIMIENTO QUE CONTENGA TALES MODIFICACIONES. Si comete un error, pida otro
formulario y empiece de nuevo.
• Llene cada uno de los espacios o cajas del formulario. La información incompleta o incorrecta puede causar demoras en el
registro del Reconocimiento.
• En casos de nacimientos múltiples hay que llenar un Reconocimiento individual para cada niño.
• El reconocimiento se habrá de rmar ante un testigo o notario público. La madre y el padre tienen que rmar sus nombres
en todas las copias del formulario y cada una de las rmas tiene que ser certicadas ante un testigo o notario público. La madre
y el padre tienen que mostrar identicación apropiada y válida al testigo o notario. Ambos padres deberán utilizar solamente sus
nombres legales. NO SE PODRÁ utilizar apodos, nombres acortados, etc. Su nombre legal es el que aparece en su certicado
de nacimiento u otros documentos ociales.
• Si ambos padres no pueden rmar el Reconocimiento a la vez, use Reconocimientos separados. Cuando rmen Reconocimientos
separados, la información sobre el niño tiene que ser idéntica en ambos formularios. Todos los espacios se tienen que llenar, y
presentarse ambos Reconocimientos simultáneamente.
• Si usted va a cambiar el nombre del niño, después de los 3 meses de edad se puede cambiar solamente el apellido del niño
usando este formulario. Se debe pedir cualquier otro cambio por la ocina de estadísticas demográcas
• Si llenan este Reconocimiento fuera del hospital, recuerde certicar las rmas ante un notario público o un testigo calicado. Un
testigo calicado tiene que tener por lo menos 18 años de edad y no tener parentesco sanguíneo o por matrimonio con ninguno de
los padres. Los notarios públicos están listados en el directorio telefónico. DEVUELVA TODAS LAS PÁGINAS DEL RECONOCI-
MIENTO (excepto las instrucciones para llenarlo). Envíe el documento completo a:
DCSS Hospital Paternity Program – HPP
PO BOX 64533
Phoenix, AZ 85082
• Si requiere una copia del certicado de nacimiento, envíe su dinero de solicitud, también con la solicitud por certicado de naci-
miento, a la dirección listada en la solicitud por certicado de nacimiento. NO envíe ningún dinero al Programa de Paternidad
en los Hospitales.
DEFINICIONES
DES - Departamento de Seguridad Económica
DHS - Departamento de Servicios de Salud
DCSS - División de Servicio de Sustento para Menores
¿CÓMO SE APROVECHARÁ SU HIJO SI USTED FIRME ESTE FORMULARIO?
• Cada niño tiene derecho de conocer a su madre y padre y sacar provecho de una relación con ambos padres.
• Su hijo tendrá tanto una madre como un padre legal.
• Su hijo tiene derecho de asistencia nanciera de ambos padres.
• Será más fácil para su hijo obtener las historias médicas de ambos padres y aprovecharse la cobertura médica disponible a usted.
• Será más fácil para su hijo heredar a través de usted y recibir benecios tales como benecios para dependientes o sobrevivientes
de la Administración de Veteranos o la Administración de Seguro Social.
Programa y Empleador con Igualdad de Oportunidades • Bajo los Títulos VI y VII de la Ley de los Derechos Civiles de 1964 (Títulos VI
y VII) y la Ley de Estadounidenses con Discapacidades de 1990 (ADA por sus siglas en inglés), Sección 504 de la Ley de Rehabilita-
ción de 1973, Ley contra la Discriminación por Edad de 1975 y el Título II de la Ley contra la Discriminación por Información Genética
(GINA por sus siglas en inglés) de 2008; el Departamento prohíbe la discriminación en la admisión, programas, servicios, actividades o
empleo basado en raza, color, religión, sexo, origen, edad, discapacidad, genética y represalias. Para obtener este documento en otro
formato u obtener información adicional sobre esta política, llame al 602-252-4045; Servicios de TTY/TDD: 7-1-1. • Ayuda gratuita con
traducciones relacionadas a los servicios del DES está disponible a solicitud del cliente. Free language assistance for DES services is
available upon request
CS-127 (11-17) Page 6
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
RECONOCIMIENTO DE PATERNIDAD
NÚM.
SÓLO PARA EJEMPLO
NO FIRME AQUÍ
INVALIDO PARA REGISTRO
FAVOR DE ESCRIBIR CLARAMENTE. Llene con TINTA NEGRA. NO ALTERE ESTE DOCUMENTO LEGAL
INFORMACIÓN DEL NIÑO
NOMBRE DEL NIÑO (Primer nombre, segundo, apellido, sujo) COMO APARECE EN EL CERTIFICADO DE NACIMIENTO
FECHA DE NACIMIENTO (Mes/día/año)
MALE
FEMALE
LUGAR DE NACIMIENTO
CIUDAD
CONDADO
ESTADO
HOSPITAL
CÓMO DESEA QUE APAREZCA EL NOMBRE DEL NIÑO EN EL CERTIFICADO DE NACIMIENTO
SI EL NOMBRE DEL NIÑO NO HA CAMBIADO, ESCRIBA EL NOMBRE TAL COMO APARECE EN EL CERTIFICADO DE NACIMIENTO ORIGINAL
PRIMER NOMBRE
SEGUNDO NOMBRE
APELLIDO
SUFIJO (Jr., II)
INFORMACIÓN DE LA MADRE
PRIMER NOMBRE
SEGUNDO NOMBRE
APELLIDO
NOMBRE DE SOLTERA
FECHA DE NACIMIENTO (Mes/día/año)
NÚM. DE SEGURO SOCIAL
CÓDIGO DE ÁREA
Y
TELÉFONO
LUGAR DE NACIMIENTO (Ciudad, estado)
PAÍS DE NACIMIENTO
DOMICILIO (Calle, núm. de apartamento, ciudad, estado, código postal ZIP)
EMPLEADOR
OCUPACIÓN
INFORMACIÓN DEL PADRE
PRIMER NOMBRE
SEGUNDO NOMBRE
APELLIDO
FECHA DE NACIMIENTO (Mes/día/año)
NÚM. DE SEGURO SOCIAL
CÓDIGO DE ÁREA
Y
TELÉFONO
LUGAR DE NACIMIENTO (Ciudad, estado) PAÍS DE NACIMIENTO
DOMICILIO (Calle, núm. de apartamento, ciudad, estado, código postal ZIP)
EMPLEADOR
OCUPACIÓN
La madre estaba casada legalmente al momento de la concepción/el nacimiento del niño.
Adjunto hay una orden del tribunal o decreto de disolución que refuta la paternidad.
Adjunto hay una renuncia de Afdávit de
Paternidad llenado por del esposo actual/anterior.
Este Reconocimiento de Paternidad se rma voluntariamente, sin amenaza, ni perjuicio ni por coacción. He recibido
aviso escrito y verbal, y he leído el AVISO DE LAS OPCIONES, LAS CONSECUENCIAS LEGALES Y LOS DERECHOS Y
RESPONSABILIDADES. Comprendo mis opciones, las consecuencias legales y los derechos y las responsabilidades. Juro y
armo bajo pena de perjurio conforme a A.R.S. §13-2702 que he examinado esta solicitud y todos los documentos adjuntos y
que según mi leal entender y saber, son ciertos y correctos.
FIRMA DE LA MADRE
(Firma solamente en presencia de un Testigo) FECHA (Mes/día/año)
FIRMA DEL
TESTIGO (SERÁ LLENADO POR [Marque uno] :
HOSPITAL
AGENCIA GUBERNAMENTAL
OTRO)
FIRMA DEL PADRE
(Firma solamente en presencia de un Testigo) FECHA (Mes/día/año)
FIRMA DEL TESTIGO (SERÁ LLENADO POR [Marque uno] :
HOSPITAL
AGENCIA GUBERNAMENTAL
OTRO)
EL TESTIGO HABRÁ DE TENER POR LO MENOS 18 AÑOS DE EDAD Y NO TENER PARENTESCO SANGUÍNEO NI POR MATRIMONIO.
NOMBRE DEL TESTIGO CON LETRA DE MOLDE
DIRECCIÓN
DIRECCIÓN
NOMBRE DEL
TESTIGO CON LETRA DE MOLDE
DIRECCIÓN
DIRECCIÓN
----------------------------------------------------------- SECCIÓN PARA EL NOTARIO ----------------------------------------------------------
LA LLENARÁ UN NOTARIO PÚBLICO SOLAMENTE EN AUSENCIA DE TESTIGOS ARRIBA
Estado de Arizona, condado
Subscrito y jurado o armado ante mí
este
día de
,
NOTARIO PÚBLICO
SELLO DEL NOTARIO AQUÍ
Mi comisión termina
Estado de Arizona, condado
Subscrito y jurado o armado ante mí
este
día de ,
NOTARIO PÚBLICO
SELLO DEL NOTARIO AQUÍ
Mi comisión termina
Marque esta cajita se llenó el formulario en el hospital.
Fecha de paternidad
Sólo para uso de ocina
TODAS LAS COPIAS DE ESTE DOCUMENTO DEBEN TENER FIRMAS ORIGINALES.
ESTE DOCUMENTO DE PATERNIDAD SE FIRMA VOLUNTARIAMENTE, SIN AMENAZA, PERJUICION NI COACCIÓN
Remueva el Formulario
Form in English
CS-127 (11-17) Page 7
AVISO DE LAS OPCIONES, LAS CONSECUENCIAS LEGALES,
LOS DERECHOS Y LAS RESPONSABILIDADES
LEA ESTA INFORMACIÓN DETENIDAMENTE ANTES DE FIRMAR EL FORMULARIO
E
l propósito de este formulario es reconocer paternidad para un niño nacido a una madre soltera.
Nosotros, la madre biológica y el padre biológico, declaramos que la información provista es cierta y correcta. Reconoce-
mos que el padre nombrado es el único padre posible del niño nombrado.
Si la madre del niño estuvo casada en cualquier momento durante los 10 meses inmediatamente anteriores al nacimiento
del niño o si el nacimiento del niño ocurrió dentro de 10 meses de haber terminado el matrimonio por causa de muerte,
anulación, declaración de invalidez o disolución del matrimonio, o después que el tribunal haya registrado un decreto de
separación legal. Según A.R.S. § 25-814, una Renuncia de Afdávit de Paternidad debe acompañar este documento.
Entiendo que si la madre no sabe el paradero del esposo actual/anterior, la madre tendrá que solicitar servicios de IV-D y
la División de Servicio de Sustento para Menores intentará localizar al esposo actual/anterior.
Entiendo que al rmar este reconocimiento cedemos nuestro derecho de una audiencia para determinar paternidad ante un
tribunal, así como nuestro derecho de pruebas genéticas para determinar la paternidad para este niño.
Entiendo además que quizá tengamos derecho de rescindir o recusar este reconocimiento conforme a A.R.S. § 25-812.
Entiendo que el rmar este reconocimiento resultará en la determinación legal de la paternidad.
Entiendo que al determinar la paternidad, ambos padres tienen una obligación legal de mantener a su hijo conforme a
A.R.S. § 25-501, así como otras obligaciones impuestas por la ley de Arizona.
Entiendo que esta determinación de paternidad no es una orden de custodia pero sirve como base para determinar asuntos
relacionados con la custodia y las visitas, y proporciona a los padres todos los derechos y responsabilidades provistos por
la ley de Arizona.
Entiendo que cualquiera de los padres tiene derecho de cancelar el Reconocimiento de Paternidad llenando un Adávit de
Rescisión de Paternidad dentro de 60 días desde la fecha de la última rma preparada ante un testigo/notario público en el
Reconocimiento, y enviándolo al Programa de Paternidad en Hospitales conforme a A.R.S. § 25-812. He leído la informa-
ción provista y recibido aviso verbal de nuestros derechos y responsabilidades bien por hablar con el personal, o por ver
un video sobre la paternidad, o por llamar aI 1-800-485-6908.
Un Reconocimiento de Paternidad voluntario registrado con el Departamento de Seguridad Económica o el Depar-
tamento de Servicios de Salud tiene el mismo peso y efecto como un fallo del Tribunal Superior conforme a A.R.S.
§ 25-812.
Declaro además que esta declaración sea hecha para ser registrada con el Secretario del Tribunal Superior, el Departa-
mento de Seguridad Económica o el Departamento de Servicios de Salud conforme a A.R.S. § 25-812, y por este acto con-
siento y pido que se enmiende el certicado de nacimiento para reejar el nombre del padre y el nombre del niño tal como
sea pedido en el frente del Reconocimiento de Paternidad. Note por favor: Cualquier pregunta relacionada con cambiar el
nombre se deberá dirigir al Departamento de Servicios de Salud, Ocina de Estadísticas Demográcas.
Entiendo que si DES lo estima apropiado, este reconocimiento se podrá utilizar para obtener una orden de paternidad en
cualquier condado con jurisdicción en Arizona.
Entiendo que conforme a 42 USC § 652(a) (7) y 666(a) (5) (IV) debo proporcionar mi número de Seguro Social. DES/
DCSS utilizará esta información para establecer paternidad y, si es apropiado, para establecer y hacer cumplir una orden
de alimentos para menores.
Juro o armo bajo pena de perjurio conforme a A.R.S. § 13-2702 que he examinado esta solicitud y/o los documentos ad-
juntos y que según mi mejor saber y entender son ciertos y correctos.
¿QUÉ SIGNIFICA SI YO FIRME ESTE FORMULARIO?
Mediante su rma en este Reconocimiento de Paternidad usted legalmente establece la paternidad de su niño. La pater-
nidad signica que usted es el padre legal del niño.
El rmar este formulario es voluntario. Usted no debe rmar este formulario si le han amenazado o coaccionado.
Este Reconocimiento no le otorga automáticamente al padre los derechos de custodia o visitas, pero él puede utilizarlo
para pedir esos derechos en el tribunal.
Cualquiera de los padres puede rescindir este formulario dentro de 60 días de la última rma en el formulario rmando un
Adávit de Rescisión de Paternidad (CS-258). Comuníquese con el Programa de Paternidad en Hospitales al 1-800-485-
6908 si desea un Adávit de Rescisión de Paternidad.
CS-127 (11-17) Page 8
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
(Departamento de Sanidad de Arizona)
Ofce of Vital Records (Ocina de Registro Civil)
INFORMACIÓN ADICIONAL SOBRE EL PADRE QUE FIGURA EN EL
RECONOCIMIENTO DE PATERNIDAD
(para el trámite de partida de nacimiento)
La Ocina de Registro Civil del Departamento de Sanidad de Arizona tiene la obligación de recabar y transmitir la información al
Centro Nacional de Estadísticas de Sanidad del Departamento de Sanidad y Servicios Humanitarios (NCHS por sus siglas en inglés).
Por favor proporcione los datos que se solicitan a continuación, los que se recaban con nes estadísticos. Gracias de antemano por
proporcionar la información.
NOMBRE DEL NIÑO (apellido, nombre, sujo) FECHA DE NACIMIENTO
NOMBRE DE LA MADRE
(apellido, nombre, inicial del segundo nombre)
NOMBRE DEL PADRE
(apellido, nombre, inicial del segundo nombre)
EDUCACIÓN DEL PADRE (marque una)
¿Cuál es el nivel más alto de educación que usted obtuvo al momento del nacimiento del niño? Marque una de las casillas que mejor des-
criba su educación. Si en la actualidad usted está matriculado, marque la casilla que indica el grado anterior o el título más alto obtenido.
8.ᵃᵛᵒ grado o menos
9.ᶰᵒ – 12.ᵃᵛᵒ grado, no diploma
Graduado de bachillerato o certicado de GED
Algunos créditos de educación superior, pero sin título
Diploma por dos años de estudios superiores (ej. AA, AS)
Licenciatura (ej. BA, AB, BS )
Maestría (ej. MA, MS MEng, Med, MSW, MBA)
Doctorado (ej. PhD, EdD) o Profesional (ej. MD, DDS, DVM, LLB, JD)
RAZA DEL PADRE (marque todo lo que corresponda)
Blanco
Negro, afroestadounidense
Amerindio o nativo de Alaska (*vea la lista a continuación)
Tribu principal o inscrita:
Tribu adicional:
Tribu adicional:
Tribu adicional:
Indio asiático
Chino
Filipino
Japonés
Coreano
Otros asiáticos
Especique:
Especique:
Hawaiano
Guameño o chamorro
Samoano
Otros isleños de la Polinesia
Especique:
Especique:
Otros
Especique:
Especique:
Desconocido Rehúsa No se puede obtener
*Por favor, seleccione de la siguiente lista la(s) tribu(s) apropiada(s) de Arizona con la(s) que el padre tiene aliación y escriba el nom-
bre de la tribu en el espacio que se da a continuación. Si el padre tiene aliación a una tribu que no es de Arizona, por favor escriba
“otros” en el espacio correspondiente o el nombre de la tribu que no pertenece a Arizona.
Comunidad Indígena Ak Chin
Tribu Navajo
Camp Verde Yavapai Apache
Pascua Yaqui
Tribu Cocopah
Comunidad Indígena Prescott Yavapai
Tribus Indígenas de Colorado River Tribu Quechan
Tribu Fort Mohave
Comunidad Indígena Salt River (Pima)
Comunidad Mohave-Apache Ft. McDowell Tribu San Carlos Apache
Comunidad Indígena Gila River (Pima) San Juan Southern Paiute Band
Tribu Havasupai
Tribu Tohono O’Odham (Papago)
Tribu Hopi
Tonto Apache
Tribu Hualapai Tribu White Mountain Apache (Fort Apache)
Kaibab Band de Indígenas Paiute
ORIGEN HISPÁNICO DEL PADRE (marque uno)
No, no soy español, hispánico o latino
Sí, soy mejicano, mejicano americano, chicano
Sí, soy portorriqueño
Sí, soy cubano
Sí, soy otro español/hispánico/latino (ej. español, salvadoreño,
dominicano, colombiano)
Especique:
Especique:
Desconocido Rehúsa No se puede obtener
Click for PDF

Form Information

Fact Name Details
Purpose of the Form This form is used to acknowledge paternity for a child born out of wedlock.
Eligibility The form is not applicable if the mother was married at the time of birth or within ten months prior, unless a Waiver of Paternity Affidavit is included.
Completion Guidelines Only black ink should be used. All required information must be filled out completely, and no corrections are allowed on the form.
Witness Requirement The Acknowledgment must be signed in the presence of a witness or a notary public. Each parent's signature must be witnessed or notarized.
Multiple Births A separate Acknowledgment must be completed for each child in cases of multiple births.
Name Changes After three months of age, only the child's last name can be changed using this form. Other changes must go through the Office of Vital Records.
Legal Consequences Signing the form establishes legal paternity, which includes obligations for financial support and rights to inheritance.
Rescission Rights Either parent can rescind the Acknowledgment within 60 days by completing an Affidavit of Paternity Rescission.
Governing Law The Acknowledgment of Paternity is governed by Arizona Revised Statutes (A.R.S.) § 25-814 and § 25-812.

Detailed Guide for Filling Out Arizona Paternity

Completing the Arizona Paternity form is an important step for establishing the legal relationship between a father and child. After filling out the form correctly, it will need to be signed in the presence of a witness or notary public. Once completed, the form must be mailed to the designated address to ensure it is processed properly.

  1. Read the entire form and accompanying instructions carefully.
  2. Use only black ink to fill out the form. Do not use colored ink.
  3. Type or print all required information clearly, except where signatures are needed.
  4. Do not make any corrections on the form. If you make a mistake, request a new form and start over.
  5. Complete every blank or box on the form. Incomplete information may cause delays.
  6. If there are multiple children, fill out a separate form for each child.
  7. Both parents must sign the form in the presence of a witness or notary public.
  8. Provide valid identification to the witness or notary public when signing.
  9. Use your legal name as it appears on official documents; do not use nicknames.
  10. If both parents cannot sign at the same time, complete separate forms but ensure the child’s information is identical on both.
  11. If changing the child’s last name, note that only the last name can be changed after three months of age using this form.
  12. Ensure the form is signed in front of a qualified witness or notary public if completed away from the hospital.
  13. Return all pages of the completed form (excluding instructions) to the designated address:
    • DCSS Hospital Paternity Program – HPP
    • PO BOX 64533
    • Phoenix, AZ 85082

Obtain Answers on Arizona Paternity

  1. What is the purpose of the Arizona Paternity form?

    The Arizona Paternity form, also known as the Acknowledgment of Paternity (CS-127), is designed to legally establish the paternity of a child born out of wedlock. This acknowledgment ensures that the child has two legal parents, which can provide various rights and benefits, including financial support and access to medical history.

  2. Who should complete the form?

    Both the mother and the father of the child should complete the form. It is essential that both parents agree to acknowledge paternity voluntarily. If the mother was married at the time of the child's birth or within ten months prior, a Waiver of Paternity Affidavit must accompany the form.

  3. How should the form be completed?

    When filling out the form, it is crucial to use black ink only. All required information must be printed clearly, and no corrections or alterations should be made. If a mistake occurs, a new form should be requested. Each parent must use their legal name as it appears on official documents, avoiding nicknames or abbreviations.

  4. What if both parents cannot sign the form at the same time?

    If both parents are unable to sign the form together, they should each complete a separate Acknowledgment of Paternity. However, it is important that the child’s information is identical on both forms, and both forms must be submitted together.

  5. What are the witnessing requirements for the signatures?

    The signatures of both parents must be witnessed or notarized. A qualified witness must be at least 18 years old and cannot be related to either parent. If signing away from the hospital, a Notary Public can also validate the signatures.

  6. What happens if the form is not filled out correctly?

    Incomplete or incorrect information can lead to delays in the processing of the Acknowledgment. It is vital to fill in every blank on the form accurately. If there are any mistakes, the parents must start over with a new form.

  7. Can the child's name be changed using this form?

    Yes, but only the last name of the child can be changed using this form if the child is over three months old. Any other name changes must be requested through the Office of Vital Records.

  8. What are the benefits of signing the Acknowledgment of Paternity?

    By signing this form, both parents establish legal paternity, which grants the child rights to financial support from both parents. Additionally, it allows the child to access medical histories and potential benefits such as Social Security or Veterans Affairs benefits.

  9. What should be done if a parent wants to rescind the acknowledgment?

    Either parent can rescind the Acknowledgment of Paternity within 60 days of the last signature by completing an Affidavit of Paternity Rescission (CS-258). This form must be submitted to the Hospital Paternity Program to cancel the acknowledgment.

Common mistakes

Filling out the Arizona Paternity form correctly is crucial for establishing legal parentage. However, many individuals make common mistakes that can lead to delays or invalidations of the acknowledgment. Here are ten frequent errors to avoid.

One major mistake is failing to read the instructions thoroughly. The form emphasizes the importance of understanding the legal consequences and rights involved. Skipping this step can result in misunderstandings about the process and the implications of signing the form.

Using the wrong ink color is another common error. The instructions clearly state that only black ink is acceptable. Submitting a form completed in any other color will lead to rejection and necessitate starting over.

Many individuals do not complete every section of the form. Incomplete information can cause significant delays in processing the acknowledgment. Each blank must be filled out completely to ensure the form is valid.

Some people forget that if the parents cannot sign the acknowledgment simultaneously, separate forms must be used. Each parent's information must match exactly on both forms. Discrepancies can complicate the acknowledgment process.

Another frequent mistake is making corrections on the form. The instructions specify that any alterations, including crossouts or erasures, will invalidate the acknowledgment. If an error occurs, it is essential to request a new form rather than attempting to fix the mistake.

Failing to provide proper identification when signing in front of a witness or notary is also a common oversight. Both parents must show valid identification to the witness or notary to ensure the signatures are legitimate.

In cases of multiple births, parents often mistakenly believe that one acknowledgment form suffices for all children. Each child requires a separate acknowledgment, and this requirement is non-negotiable.

Some individuals neglect to ensure that the names used on the form match the legal names on official documents. Using nicknames or shortened versions can lead to complications and potential legal issues down the line.

Lastly, individuals sometimes forget to return all pages of the acknowledgment, excluding the instruction page. The entire document must be submitted to the designated address to complete the process successfully.

By being aware of these common mistakes, individuals can better navigate the paternity acknowledgment process in Arizona, ensuring that their forms are completed accurately and submitted without unnecessary delays.

Documents used along the form

When navigating the process of establishing paternity in Arizona, several forms and documents may accompany the Arizona Paternity form (CS-127). Each of these documents plays a crucial role in ensuring that all legal aspects of paternity acknowledgment are addressed properly. Here’s a brief overview of these important forms.

  • Waiver of Paternity Affidavit: This document is necessary if the mother was married at the time of the child's birth or during the ten months leading up to it. It allows the mother's husband to waive his rights to paternity, enabling the acknowledgment of another man as the legal father.
  • Affidavit of Paternity Rescission: If either parent wishes to cancel the acknowledgment of paternity, this form must be completed within 60 days of signing the Acknowledgment of Paternity. It formally rescinds the paternity acknowledgment.
  • Birth Certificate Application: To obtain a birth certificate that reflects the father's name after paternity is established, this application must be submitted. It typically requires payment and may need to be accompanied by other identification documents.
  • Child Support Order: Once paternity is established, a child support order may be necessary to ensure financial support for the child. This document outlines the financial responsibilities of both parents.
  • Parenting Plan: While not mandatory, a parenting plan can help outline custody arrangements, visitation schedules, and decision-making responsibilities between parents. This plan can be presented to the court for approval.
  • Genetic Testing Results: If paternity is in question, genetic testing may be conducted. The results can be critical in establishing legal paternity and may be required by the court.
  • Notification of Rights and Responsibilities: This document outlines the legal rights and obligations of both parents once paternity is acknowledged. It serves as a guide to understanding the implications of signing the Acknowledgment of Paternity.
  • Court Order of Paternity: If paternity is disputed, a court order may be necessary to legally establish paternity through a judge's ruling. This document is essential for legal proceedings.
  • Child's Medical History Form: This form collects important medical information from both parents, which can be beneficial for the child's healthcare needs and future medical decisions.

Understanding these documents is vital for parents navigating the paternity acknowledgment process in Arizona. Each form serves a specific purpose and helps ensure that the rights and responsibilities of both parents are clearly defined and legally recognized. Proper completion and submission of these forms can facilitate a smoother experience in establishing paternity and securing the best interests of the child.

Similar forms

  • Birth Certificate Application: Similar to the Arizona Paternity form, a birth certificate application requires detailed information about the child and parents. Both documents aim to establish legal recognition of parentage, ensuring that the child's identity and lineage are officially recorded.
  • Child Support Agreement: This document outlines the financial responsibilities of parents towards their child. Like the Paternity form, it emphasizes the legal obligations of both parents and ensures that the child receives adequate support from both parties.
  • Custody Agreement: A custody agreement determines the living arrangements and visitation rights for a child. This document, like the Paternity form, is essential for establishing legal relationships and responsibilities between parents, particularly in cases where parents are not together.
  • Affidavit of Paternity Rescission: This document allows parents to rescind their acknowledgment of paternity within a specified time frame. It serves a similar purpose to the Paternity form by addressing legal parentage, but it focuses on undoing the acknowledgment rather than establishing it.

Dos and Don'ts

When filling out the Arizona Paternity form, it is essential to follow specific guidelines to ensure proper completion. Below is a list of things to do and avoid.

  • Use only black ink. Colored inks are not acceptable.
  • Fill in every blank. Incomplete forms may cause delays.
  • Sign in the presence of a witness or notary. Each signature must be witnessed or notarized.
  • Ask for a new form if mistakes occur. Do not make corrections on the form.
  • Do not use nicknames. Use your legal name as it appears on official documents.
  • Do not submit incomplete forms. Ensure all information is accurate and complete.
  • Do not alter the form. Crossouts or changes will invalidate the Acknowledgment.
  • Do not forget to return all pages. Exclude only the instruction page when mailing.

Misconceptions

  • Misconception 1: The form can be completed in any ink color.

    • Many people believe they can use any color ink to fill out the Arizona Paternity form. However, it is explicitly stated that only black ink is acceptable. Using colored ink will invalidate the form.

  • Misconception 2: Corrections can be made on the form.

    • Some individuals think they can make corrections on the Acknowledgment of Paternity form. In reality, any form that contains crossouts, erasures, or alterations will be invalid. If a mistake is made, a new form must be requested.

  • Misconception 3: Only one Acknowledgment is needed for multiple births.

    • It is a common misunderstanding that one form suffices for multiple births. Each child requires a separate Acknowledgment of Paternity to be completed and submitted.

  • Misconception 4: The form does not require a witness or notary.

    • Some people believe that a witness or notary is not necessary for the signing of the form. However, both parents must sign the Acknowledgment in the presence of a witness or a notary public to validate the document.

  • Misconception 5: The form can be signed at any location without specific requirements.

    • It is often thought that the Acknowledgment can be signed anywhere. If signing away from the hospital, it must be done in the presence of a qualified witness or notary public, who must meet specific criteria.

  • Misconception 6: The Acknowledgment automatically grants custody or visitation rights.

    • Some individuals assume that signing the Acknowledgment of Paternity gives the father automatic custody or visitation rights. In fact, it establishes paternity but does not confer these rights, which must be pursued separately in court.

  • Misconception 7: The Acknowledgment can be rescinded at any time.

    • Many believe they can change their minds about the Acknowledgment whenever they wish. However, there is a specific timeframe of 60 days from the last signature during which the Acknowledgment can be rescinded.

  • Misconception 8: The form is only necessary for financial support.

    • Some people think the Acknowledgment is solely about financial obligations. In reality, it also serves to establish legal parenthood, allowing children to know their parents, access medical histories, and inherit benefits.

Key takeaways

Filling out the Arizona Paternity form (CS-127) is a significant step for parents looking to establish legal fatherhood. Here are some key takeaways to keep in mind:

  • Use Black Ink Only: When completing the form, it is essential to use black ink. Any other color will not be accepted and could invalidate the document.
  • Complete Every Section: Ensure that all blanks and boxes are filled out completely. Missing information can lead to delays in processing the Acknowledgment of Paternity.
  • Witness or Notarize Signatures: The signatures of both parents must be witnessed or notarized. This requirement ensures that the Acknowledgment is legally binding and protects the rights of both parents.
  • Do Not Alter the Form: Avoid making corrections on the form. Any crossouts, erasures, or alterations will invalidate the Acknowledgment. If an error occurs, request a new form.
  • Understand the Legal Implications: By signing this form, both parents are establishing legal paternity, which includes rights and responsibilities regarding child support and custody. Be aware that this acknowledgment can be rescinded within 60 days if necessary.