Form DHS-3159-ENG "Minnesota Voluntary Recognition of Parentage" - Minnesota

What Is Form DHS-3159-ENG?

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

Form Details:

  • Released on May 1, 2018;
  • The latest edition provided by the Minnesota Department of Human 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 DHS-3159-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.

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Download Form DHS-3159-ENG "Minnesota Voluntary Recognition of Parentage" - Minnesota

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DHS-3159-ENG 5-18
Minnesota Voluntary Recognition of Parentage
Purpose
Signing and filing this Recognition of Parentage (ROP) form establishes a legal relationship between a father and
child when the biological father is not married to the child's mother. Signing and filing this form:
• Legally establishes the biological father's paternity
• Creates and waives certain rights and responsibilities for the mother, father and child
• Allows the father's name to be on the child's birth record
• Provides a basis for establishing child support
• Does not establish custody or parenting time.
Instructions for parents
Get answers to your questions before you sign this form. Signing this form is voluntary. If, you are unsure who the
biological father is, you should not sign this document and you should have a genetic test. To obtain a genetic test,
contact your county child support office or seek genetic testing services on your own. A Recognition of Parentage can
be revoked by either parent if a written revocation signed by that parent in front of a notary public is filed with the
Minnesota Department of Health, Office of Vital Records within 60 days after the Recognition of Parentage is signed.
After 60 days, a fully executed and filed Recognition of Parentage has the same force and effect as a court order
establishing paternity. Upon filing, the Department of Health will update the birth record with the father's name.
If you want to voluntarily establish the legal relationship between a father and child when the father is not married
to the child's mother:
• Read all four pages of this form and the booklet Being a Legal Father: Parentage information for mothers and
fathers (DHS-3159A) carefully or have someone read them to you
• Watch the paternity establishment video
• If the mother was married to a person other than the child's biological father, the mother's spouse must also sign
and submit a Spouse's Non-Parentage Statement and file with the Minnesota Department of Health
• Fill out all of this form with information that matches your child's birth record
• Ask for a new form if you make a mistake. Do not cross out words, leave blanks or make corrections
• Sign this form in front of a notary public
• File this completed form with the Minnesota Department of Health.
When you sign this form, you may also change your child's last name from what is on your child's birth record. If
you want to change the last name and both parents agree, write your child's new last name in the designated box. If
you do not want to change the last name or if your child's birth record is not filed yet, write your child's current last
name in the box.
Instructions for assisting agencies
• Provide verbal notice to the parents of their rights, responsibilities and their alternatives to signing this
Recognition of Parentage.
• Complete the Agency section on the bottom of the completed Recognition of Parentage by checking a box and
writing the name of the agency where the form is completed.
• Fax or send the form to the Minnesota Department of Health.
• Give each parent a copy of the form and keep the original or a copy for your records.
• Follow your agency's policies and procedures for contacting the parents to sign and file a new form if you
become aware that the form is rejected by the Minnesota Department of Health.
Fax this completed form to 651-215-5834.
If you are unable to fax this form, mail it to:
Minnesota Department of Health
Office of Vital Records
P.O. Box 64499
St. Paul, MN 55164-0499
DHS-3159-ENG 5-18
Minnesota Voluntary Recognition of Parentage
Purpose
Signing and filing this Recognition of Parentage (ROP) form establishes a legal relationship between a father and
child when the biological father is not married to the child's mother. Signing and filing this form:
• Legally establishes the biological father's paternity
• Creates and waives certain rights and responsibilities for the mother, father and child
• Allows the father's name to be on the child's birth record
• Provides a basis for establishing child support
• Does not establish custody or parenting time.
Instructions for parents
Get answers to your questions before you sign this form. Signing this form is voluntary. If, you are unsure who the
biological father is, you should not sign this document and you should have a genetic test. To obtain a genetic test,
contact your county child support office or seek genetic testing services on your own. A Recognition of Parentage can
be revoked by either parent if a written revocation signed by that parent in front of a notary public is filed with the
Minnesota Department of Health, Office of Vital Records within 60 days after the Recognition of Parentage is signed.
After 60 days, a fully executed and filed Recognition of Parentage has the same force and effect as a court order
establishing paternity. Upon filing, the Department of Health will update the birth record with the father's name.
If you want to voluntarily establish the legal relationship between a father and child when the father is not married
to the child's mother:
• Read all four pages of this form and the booklet Being a Legal Father: Parentage information for mothers and
fathers (DHS-3159A) carefully or have someone read them to you
• Watch the paternity establishment video
• If the mother was married to a person other than the child's biological father, the mother's spouse must also sign
and submit a Spouse's Non-Parentage Statement and file with the Minnesota Department of Health
• Fill out all of this form with information that matches your child's birth record
• Ask for a new form if you make a mistake. Do not cross out words, leave blanks or make corrections
• Sign this form in front of a notary public
• File this completed form with the Minnesota Department of Health.
When you sign this form, you may also change your child's last name from what is on your child's birth record. If
you want to change the last name and both parents agree, write your child's new last name in the designated box. If
you do not want to change the last name or if your child's birth record is not filed yet, write your child's current last
name in the box.
Instructions for assisting agencies
• Provide verbal notice to the parents of their rights, responsibilities and their alternatives to signing this
Recognition of Parentage.
• Complete the Agency section on the bottom of the completed Recognition of Parentage by checking a box and
writing the name of the agency where the form is completed.
• Fax or send the form to the Minnesota Department of Health.
• Give each parent a copy of the form and keep the original or a copy for your records.
• Follow your agency's policies and procedures for contacting the parents to sign and file a new form if you
become aware that the form is rejected by the Minnesota Department of Health.
Fax this completed form to 651-215-5834.
If you are unable to fax this form, mail it to:
Minnesota Department of Health
Office of Vital Records
P.O. Box 64499
St. Paul, MN 55164-0499
For accessible formats of this publication or
assistance with additional equal access to
human services, write to DHS.Info@state.mn.us,
call 651-431-4400, or use your preferred relay
service.
(ADA1 [9-15])
Clear Form
DHS-3159-ENG 5-18
MINNESOTA DEPARTMENT OF HUMAN SERVICES
Minnesota Voluntary Recognition of Parentage
FIRST NAME
MIDDLE NAME
LAST NAME
SUFFIX (Jr., Sr., I, II, etc.)
DATE OF BIRTH
BIRTH PLACE (city/state)
Do you want to change your child's last name?
CHILD'S LAST NAME
Yes
No
If yes, write the new last name in the box to the right.
If no, write the current last name in the box to the right.
FIRST NAME
MIDDLE NAME
LAST NAME
SUFFIX
DATE OF BIRTH
(mm/dd/yyyy)
BIRTH PLACE (city/state)
SOCIAL SECURITY NUMBER
PHONE NUMBER
(optional)
MAILING ADDRESS
CITY
STATE
ZIP CODE
Were you married to a person other than the biological father when this child was conceived or born?
Yes
No
If yes, the spouse/ex-spouse must also file a Spouse's Non-parentage Statement (Form DHS-3159C) within one
year of this child's birth to put the name of the biological father on this child's birth record.
FIRST NAME
MIDDLE NAME
LAST NAME
SUFFIX
DATE OF BIRTH
(mm/dd/yyyy)
BIRTH PLACE (city/state)
SOCIAL SECURITY NUMBER
PHONE NUMBER
(optional)
MAILING ADDRESS
CITY
STATE
ZIP CODE
By signing this Recognition of Parentage, I swear or affirm all the following:
• I am the biological parent of the child named above.
• I understand that signing this form allows the court to order
• The rights, responsibilities, alternatives and legal consequences
child support.
associated with signing this form as outlined in the Parent's
• I am voluntarily signing this form for the purpose of establishing
statement, Waiver of rights and Custody and parenting time
paternity for my child and making sure both parents are listed on
information sections of this form have been explained to me
my child's birth record.
verbally and/or in writing and I understand and accept them
• I understand that I have the right to revoke this Recognition of
• To the best of my knowledge, all of the above information is true
Parentage within 60 days. I understand that I may revoke the
and correct.
Recognition of Parentage by signing a written revocation in front
• I understand that I have the right to genetic tests. If I have not had
of a notary public and filing it with the Minnesota Department of
genetic testing, I am certain that the father listed above is the
Health, Office of Vital Records. I understand that if the
biological father of the child.
Recognition of Parentage is not revoked within 60 days, it has
• I understand that signing this form does not establish custody or
the same force and effect as a court order establishing paternity
parenting time and the mother has sole custody until a court
and would take a court order to undo.
orders otherwise.
Mother's signature x_______________________________
Biological father's signature x_______________________
In the state of _________________, County of______________________
In the state of _________________, County of______________________
Signed and sworn/affirmed to before me this (mm/dd/yy):
Signed and sworn/affirmed to before me this (mm/dd/yy):
/
/
/
/
__________________________________
______________________
__________________________________
______________________
Notary Public Signature
My commission expires
Notary Public Signature
My commission expires
Form completed at:
MDH
DHS
County
Hospital
Other
(agency name)
DHS-3159-ENG 5-18
Parent's statement
• I understand that this is a legal document. If we are
both age 18 or older when we sign this form, this
I swear/affirm that:
Recognition of Parentage is the same as a court order
• I have been told about the Recognition of Parentage
determining the legal relationship between a father
form and understand my rights and responsibilities
and child.
created and waived by signing this form.
• I understand that if either of us is under age 18 when
• I have a copy of Being a Legal Father: Parentage
we sign this form, this Recognition of Parentage is only
information for mothers and fathers (DHS-3159A). I
a presumption of paternity. It is not final. I understand
read the booklet or had someone else read it to me.
that I have six months after the youngest of us turns 18
• I have received additional oral notice about my rights,
to take legal action to declare the nonexistence of the
responsibilities and alternatives to signing this form,
father and child relationship.
and/or had the opportunity the view the paternity
• I understand that either of us can cancel this
establishment video which is available online and at
Recognition of Parentage by stating in writing that, "I
all county child support offices.
am revoking the Recognition of Parentage." I
• I understand that either of us may choose not to
understand that I must sign the revocation in front of a
acknowledge paternity. As alternatives to signing the
notary public and that I must file the revocation with
Recognition of Parentage, either of us could ask the
the Office of Vital Records within 60 days after I sign
court to decide on paternity or we could acknowledge
this form. If I have not filed a revocation within 60
paternity later.
days, I understand that this Recognition of Parentage
• I acknowledge that we are the biological parents of the
will have the same force and effect as a court order
child named in this Recognition of Parentage.
establishing paternity. If I still want to cancel this
• I understand that this Recognition of Parentage
Recognition of Parentage after the 60 days, I
does not give custody or parenting time to the legal
understand that I will need to take legal action to
father. However, this Recognition of Parentage gives
request that the court change any of the information in
the father the right to ask the court for temporary or
this Recognition of Parentage which the court may or
permanent custody and/or parenting time.
may not do.
• If I sign this Recognition of Parentage and pursue a
• I understand that this Recognition of Parentage will
court order for custody, I understand that under
not be considered valid if the mother of the child was
Minnesota Statutes Chapter 518, there is no
married to another person at the time this child was
presumption for or against joint physical custody
conceived or born unless this Recognition of Parentage
except in cases involving domestic abuse between the
is filed in conjunction with a Spouse's Non-parentage
parents.
Statement.
• I understand that either of us can take legal action to
• To the best of my knowledge, the information on this
establish paternity instead of signing the Recognition
form is true.
of Parentage and that either of us may apply for
• I am signing this form voluntarily. No one forced me
paternity establishment services at our local child
to sign this Recognition of Parentage.
support office.
• I understand that either of us can choose to have
Waiver of rights
genetic testing done before we sign the Recognition of
By signing this Minnesota Voluntary ROP form
Parentage.
(DHS-3159), you give up the right to:
• I accept responsibility to provide financial child
• Participate in a paternity proceeding, where an
support for my child. I understand that a court can
attorney could represent me
order financial child support that can include
• A trial to determine if the man is the biological father
payments for basic, medical and child care support
of the child
going back to the date of my child's birth or two years
• Cross-examine witnesses in a paternity proceeding
from the start of a legal action, whichever is earlier,
• Testify about who is the biological father of the child in
and continuing until a court order for support ends.
a paternity proceeding.
• I understand that financial support can also include
the following: reimbursement of public assistance
Custody and parenting time information
furnished for the benefit of my child, reimbursement
When a child is born to parents who are not married to
of the pregnancy and confinement expenses
each other the law gives custody of the child to the
associated with my child's birth, reimbursement of
mother. If either parent wants a different custody
any genetic testing fees paid by the public authority.
arrangement, the parents must go to court.
• I understand that both parents have the right to all
Please contact an attorney if there are any questions.
notices of any adoption proceedings.
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