Free Birth Record, Petition to Correct - Massachusetts


File Size: 584.1 kB
Pages: 1
Date: February 19, 2008
File Format: PDF
State: Massachusetts
Category: Family Law
Word Count: 264 Words, 1,603 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.mass.gov/courts/courtsandjudges/courts/probateandfamilycourt/documents/cjd118.pdf

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Commonwealth of Massachusetts
Division

The Trial Court Probate and Family Court Department

Docket No.

PETITION FOR CORRECTION OF BIRTH RECORD
, Petitioner V. in his/her official capacity as City/Town Clerk of , Respondent .

(name of city or town)

1. Now comes the petitioner who seeks to correct the birth certificate of The child was born on in 2. Petitioner, who resides at
(Street Address)
(County) (State)

(name of child) (city or town of birth)

(date of birth) (county of birth)

in , Massachusetts.

(City/Town)
(Zip)

is the 3. On State of

(relationship, i.e., mother, legal father) (date of judgment) (name of state)

of the child.
(name of out of state court)

, the

,

, entered a judgment or order establishing the paternity of the child under

the laws of that state. A CERTIFIED copy of that judgment or order is filed with this petition. 4. On or about
(date)

the petitioner presented a certified copy of the judgment or order to the

respondent with the request that the respondent prepare a new birth certificate for the child consistent with the judgment of the Court and substitute the new certificate for the old certificate, but the respondent declined to do so. 5. Wherefore petitioner requests that this Court enter an order that the respondent prepare a new birth certificate for the child consistent with the judgment and substitute the new certificate for the old certificate, as provided by G.L. c. 46 13.

Date

(Signature of attorney or plaintiff, if pro se) (Print name)

(Street address)

(City/Town)

(State)

(Zip)

Tel. No. B.B.O. #

CJ-D 118 (4/07)

C.G.F