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Get Acknowledgment For Budget

ACKNOWLEDGMENT OF PATERNITY INQUIRY REQUEST FORM Budget ZZ712 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 Name and address of Person making the Inquiry First Middle Last Address City State Daytime Telephone Number Zip Code Fax number Family Code 160. 313 limits 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 to SIGNATURE OF REQUESTOR DATE This inquiry request requires a search fee. A copy of government issued identification is required* 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 512-458-7233 and paid with a MasterCard Visa Discover or American Express. If faxed M/C VISA DISCOVER ACCT EXP DATE VS-134. 1 Rev 07/2010 American Express NAME OF CARDHOLDER Mail To Vital Statistics Unit MC 1966 P. O. BOX 12040 Austin Texas 78711-2040 CARDHOLDER ADDRESS 3 - DIGIT SECURITY CODE Found on back of card CARDHOLDER PHONE NUMBER INCLUDING AREA CODE. 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 Name and address of Person making the Inquiry First Middle Last Address City State Daytime Telephone Number Zip Code Fax number Family Code 160. 313 limits 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 to SIGNATURE OF REQUESTOR DATE This inquiry request requires a search fee. 313 limits 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 to SIGNATURE OF REQUESTOR DATE This inquiry request requires a search fee. A copy of government issued identification is required* If paying by credit card the fee is 12. 25. A copy of government issued identification is required* 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. 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 512-458-7233 and paid with a MasterCard Visa Discover or American Express..

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