Form JFS01694 "Ohio Putative Father Registry - Registration for Fathers" - Ohio

What Is Form JFS01694?

This is a legal form that was released by the Ohio Department of Job and Family Services - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2015;
  • The latest edition provided by the Ohio Department of Job and Family Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JFS01694 by clicking the link below or browse more documents and templates provided by the Ohio Department of Job and Family Services.

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Download Form JFS01694 "Ohio Putative Father Registry - Registration for Fathers" - Ohio

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Ohio Department of Job and Family Services
OHIO PUTATIVE FATHER REGISTRY - REGISTRATION FOR FATHERS
Ohio Putative Father Registry
P.O. Box 183204
Columbus, Ohio 43218
Phone: 1-888-313-3100 / Fax (614) 728-6726
OhioPFR@jfs.ohio.gov
The following information, if it is complete and submitted within 15 days of the child's birth, will enable you to
be notified in the case of an adoption proceeding involving a child of whom you may be the father.
SECTION I:
IDENTIFYING INFORMATION ABOUT THE FATHER
Father's LAST Name
FIRST Name
MIDDLE Name
Social Security Number
Phone Number
Date of Birth (MM/DD/YY)
Race
Other names by which father may be known
1.
3.
2.
4.
Home Address
Father's Email Address
City, State, Zip
Father's Mailing Address/Apt. (If different than above)
City, State, Zip
SECTION II: IDENTIFYING INFORMATION ABOUT THE MOTHER
Mother's LAST Name
FIRST Name
MIDDLE Name
Social Security Number
Phone Number
Date of Birth (MM/DD/YY)
Race
Other names by which mother may be known
1.
3.
2.
4.
Home Address
City, State, Zip
Mother's Mailing Address/Apt. (If different than above)
City, State, Zip
JFS 01694 (Rev. 3/2015)
Page 1 of 2
Reset Form
Ohio Department of Job and Family Services
OHIO PUTATIVE FATHER REGISTRY - REGISTRATION FOR FATHERS
Ohio Putative Father Registry
P.O. Box 183204
Columbus, Ohio 43218
Phone: 1-888-313-3100 / Fax (614) 728-6726
OhioPFR@jfs.ohio.gov
The following information, if it is complete and submitted within 15 days of the child's birth, will enable you to
be notified in the case of an adoption proceeding involving a child of whom you may be the father.
SECTION I:
IDENTIFYING INFORMATION ABOUT THE FATHER
Father's LAST Name
FIRST Name
MIDDLE Name
Social Security Number
Phone Number
Date of Birth (MM/DD/YY)
Race
Other names by which father may be known
1.
3.
2.
4.
Home Address
Father's Email Address
City, State, Zip
Father's Mailing Address/Apt. (If different than above)
City, State, Zip
SECTION II: IDENTIFYING INFORMATION ABOUT THE MOTHER
Mother's LAST Name
FIRST Name
MIDDLE Name
Social Security Number
Phone Number
Date of Birth (MM/DD/YY)
Race
Other names by which mother may be known
1.
3.
2.
4.
Home Address
City, State, Zip
Mother's Mailing Address/Apt. (If different than above)
City, State, Zip
JFS 01694 (Rev. 3/2015)
Page 1 of 2
SECTION III: IDENTIFYING INFORMATION ABOUT THE CHILD
Child's LAST Name
FIRST Name
MIDDLE Name
Sex
Race
Male
Female
Estimated Due Date of Mother (MM/YY)
Child's Date of Birth (MM/DD/YY)
Child's Birthplace
City
State
Hospital name, if any
Birth Certified
Multiple Birth
Yes
No
Yes
No
SECTION IV: ACKNOWLEDGEMENT
I have read, or someone has read to me, the instructions to Putative Fathers before signing this form, and I
understand that completing this form is not enough to protect my rights to be legal father of the child
identified on this form. For further information on filing a parentage action form contact:
Office of Child Support Enforcement
Ohio Department of Job and Family Services
th
30 E. Broad Street 38
Floor
Columbus, Ohio 43215
1-800-686-1556
You must submit the completed and signed form either electronically, in person, by mail or overnight mail
delivery service to:
Mailing address:
Physical/Overnight Delivery Address:
Ohio Department of Job and Family Services
Ohio Department of Job and Family Services
Ohio Putative Father Registry
Ohio Putative Father Registry
th
P.O. Box 183204
4200 E. 5
Ave.
Columbus, Ohio 43218
Columbus, Ohio 43218-3204
Fax:
Email:
(614) 728-6726
OhioPFR@jfs.ohio.gov
I certify that the information provided above is true and correct to the best of my knowledge. I
understand that a person who knowingly or intentionally registers false information on this form
commits a Misdemeanor of the First Degree.
I understand that I must tell the Putative Father Registry if I change my address or if any other
information changes on the form so that I can be located if the child I have identified becomes the
subject of an adoption.
Signature of Putative Father
Date
JFS 01694 (Rev. 3/2015)
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