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Get AR Acknowledgment of Paternity

, State Date of Birth- MM/DD/YY Male or Female Hospital If you are completing this form after the birth certificate has been filed and want to change your child’s last name, put your child’s current last name above. Put the new last name for your child here (Please Print): ____________________________________________. MOTHER’S INFORMATION Name of Mother – First, Middle, Last Maiden Mother’s Address (Street, City, State & Zip Code) Mother’s Social Security Number * Mother’s.

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