Free patreport - Colorado

STATE OF COLORADO

REPORT OF PATERNITY DETERMINATION
This form can be filled out and printed at the following Web address: www.cdphe.state.co.us/certs/patreport.pdf Reset Reset This document must contain the signature and seal of the District/Juvenile court and cannot be submitted online. Please reset before exiting.
first middle last

1. CHILD'S NEW NAME: PARENTS: THE INFORMATION IN THIS BOX WILL APPEAR ON THE CHILD'S NEW BIRTH CERTIFICATE
first middle state maiden name country if not U.S.A last state country if not U.S.A

2. MOTHER'S MAIDEN NAME: 2A. MOTHER'S BIRTH DATE
first

2B. MOTHER'S BIRTH PLACE:
middle

3. FATHER'S FULL NAME: 3A. FATHER'S BIRTH DATE 4. MOTHER'S CURRENT MAILING ADDRESS:
city/town state street or box # zip

3B. FATHER'S BIRTH PLACE:
street or box #

4A. MOTHER'S DAYTIME PHONE #: 5. FATHER'S CURRENT MAILING ADDRESS:
city/town state zip

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--

5B. Parents' Driver's License #: ATTORNEY OR AGENCY 6. CONTACT NAME:
street or box #

State of License

5A. FATHER'S DAYTIME PHONE #: Expiration Date

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(To be contacted for additional information if needed)

Attorney ID #:

6A. FIRM OR AGENCY:
city/town state zip

6B. ADDRESS: 6C. CONTACT PHONE #: --
first

--
middle

6D. E-MAIL ADDRESS:
last

THIS INFORMATION IS NEEDED TO LOCATE AND SEAL THE ORIGINAL BIRTH CERTIFICATE (see item E. on back of form) 7. CHILD'S NAME AT BIRTH:
county state maiden name last

7A. SEX: 8C. BIRTHPLACE:
first middle middle

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country if not U.S.A

8B. BIRTHDATE: 8. MOTHER'S MAIDEN NAME:
first

9. FATHER'S NAME: CERTIFICATION OF CLERK OF COURT

I hereby certify that the child identified above was decreed to be the child of the above named parents on the ______ day of __________________, 20_____ and is now to bear the name of ______________________________________________________________________________________ as set forth in the decree of Paternity in the District/Juvenile Court of ________________________________County, Colorado.

Case number _______________ Signature and seal of court _______________________________________________ Date _____/_____/_______ By _____________________________________________________ Deputy Clerk

Return form and applicable fees (see item D. on back of form) to: Vital Records/Paternity Determination Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South HSVR-VR-A1 Denver, CO 80246-1530

Contact information: Vital Records Paternity Specialist Phone: 303-692-2230 E-mail: [email protected]
patreport.pmd (rev 7/08)

INSTRUCTIONS
A. An electronic version of this form can be filled out and printed by going to the following Web address: www.cdphe.state.co.us/certs/patreport.pdf. You must then obtain the signature and seal of the District/Juvenile court and mail the completed report to Vital Records. B. Colorado law (C.R.S. 25-2-107 and 25-2-113) authorizes the preparation of a new birth certificate for a person born in Colorado following a decree of paternity. To avoid unnecessary delay in filing the new birth certificate, please complete this form carefully. C. For children born outside of Colorado the report of paternity determination will be forwarded to the appropriate state vital statistics office. D. Make check or money order payable to Vital Records. Please do not send cash. The fee for processing a change is $20.00. The first certified copy costs $17.75. Additional certified copies, ordered at the same time, cost $10.00 each. Please return with a photocopy of your driver's license, state ID or passport. If you have questions call (303) 692-2230 or e-mail [email protected]. E. The original birth certificate will be pulled from the working files and indices and placed in a sealed file along with the report of paternity determination. This sealed file shall not be subject to inspection except as provided in section 25-2-113.5, upon order of a court of competent jurisdiction, or as provided by regulation.