Form DHS-3159C-HMN "Minnesota Voluntary Recognition of Parentage Spouse's Non-parentage Statement" - Minnesota (Hmong)

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Download Form DHS-3159C-HMN "Minnesota Voluntary Recognition of Parentage Spouse's Non-parentage Statement" - Minnesota (Hmong)

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DHS-3159C-HMN 6-18
Minnesota Kev Txaus Siab Lees Paub Txog Kev Ua
Leej Niam Leej Txiv Tus Khub Nqe Lus Tsis Lees
Tias Yog Leej Txiv
Lub hom phiaj
Kev kos npe thiab teev daim Tus Khub Nqe Lus Tsis Lees Tias Yog Leej Txiv (Spouse's Non-parentage
Statement - SNPS) yuav xaus txoj kev sib txheeb raws txoj cai ntawm tus neeg uas ntseeg tias yog leej txiv
thiab tus me nyuam thaum uas tseem kos npe thiab teev daim Kev Lees Paub Txog Kev Ua Leej Niam Leej
Txiv (Recognition of Parentage - ROP) nrog rau Minnesota Tuam Tsev Pab Txog Txoj Kev Noj Qab Haus
Huv, Hoob Kas rau Ntaub Ntawv Tseem Ceeb (Minnesota Department of Health, Office of Vital Records).
Cov ncauj lus qhia
Kev kos npe rau daim ntawv no yog nyob ntawm seb koj puas txaus siab. Nov yog ib daim ntawv raws kev raws
cai. Thaum kos npe, nrog rau ib daim ROP uas ua raws kev cai, ces yuav rho koj lub npe tawm ntawm tus me
nyuam daim ntawv yug thiab leej txiv yug lub npe, raws li sau tseg hauv daim ROP, yuav muab ntxiv rau tus me
nyuam daim ntawv yug.
Ua tib zoo nyeem tag nrho daim ntawv no los sis hais kom leej twg nyeem rau koj. Yog tias koj tsis nkag siab ib
yam twg, tsis txhob kos npe rau thiab thov kev pab. Nrhiav lus teb rau koj cov lus nug ua ntej koj kos npe rau
daim ntawv no.
Yog koj yog tus uas xav tias yog leej txiv thiab koj xav xaus koj txoj kev sib txheeb ib tug me nyuam uas yug los
thaum neb tseem sib yuav los sis hauv 280 hnub tom qab koj nrauj tus me nyuam leej niam lawm:
• Teev ntawv rau txhua yam uas thov qhia hauv daim no
• Siv tej npe thiab xov xwm uas yuav phim tus me nyuam daim ntawv yug
• Thov kom tau ib daim tshiab yog tias koj sau yuam kev. Tsis txhob sau ib kab ntawv dhau plaws tej lo lus los
sis muab kho li ca
• Kos npe rau daim ntawv no rau ntawm ib tug neeg nias thwj ua tim khawv
• Teev daim ntawv thim tawm nrog rau Minnesota Tuam Tsev rau Kev Noj Qab Nyob Zoo ua ntej dhau ib
xyoos tom qab tus me nyuam yug los.
Xa duab fax txog daim no uas ua tiav mus rau 651-215-5834.
Yog tias koj tsis muaj cuab kav xa duab fax, ces xa daim no tuaj rau:
(Minnesota Tuam Tsev rau Kev Noj Qab Nyob Zoo)
(Hoob Kas rau Ntaub Ntawv Tseem Ceeb)
Minnesota Department of Health
Office of Vital Records
PO Box 64499
St. Paul, MN 55164-0499
Yog tias koj tsis nkag siab ib yam twg hauv daim ntawv no, thov kev pab.
Kom tau cov xov xwm sau ua lwm hom ntawv, thov koj
tus neeg ua hauj lwm hauv lub nras. Kom tau kev pab
rau lwm yam kev txais kev pab tib neeg yam sib txig, hu
koj lub nras tus Neeg Saib Xyuas ADA (Txoj Cai hais txog
Neeg Amelikas Xiam Hoob Khab).
ADA4 (2-18)
DHS-3159C-HMN 6-18
Minnesota Kev Txaus Siab Lees Paub Txog Kev Ua
Leej Niam Leej Txiv Tus Khub Nqe Lus Tsis Lees
Tias Yog Leej Txiv
Lub hom phiaj
Kev kos npe thiab teev daim Tus Khub Nqe Lus Tsis Lees Tias Yog Leej Txiv (Spouse's Non-parentage
Statement - SNPS) yuav xaus txoj kev sib txheeb raws txoj cai ntawm tus neeg uas ntseeg tias yog leej txiv
thiab tus me nyuam thaum uas tseem kos npe thiab teev daim Kev Lees Paub Txog Kev Ua Leej Niam Leej
Txiv (Recognition of Parentage - ROP) nrog rau Minnesota Tuam Tsev Pab Txog Txoj Kev Noj Qab Haus
Huv, Hoob Kas rau Ntaub Ntawv Tseem Ceeb (Minnesota Department of Health, Office of Vital Records).
Cov ncauj lus qhia
Kev kos npe rau daim ntawv no yog nyob ntawm seb koj puas txaus siab. Nov yog ib daim ntawv raws kev raws
cai. Thaum kos npe, nrog rau ib daim ROP uas ua raws kev cai, ces yuav rho koj lub npe tawm ntawm tus me
nyuam daim ntawv yug thiab leej txiv yug lub npe, raws li sau tseg hauv daim ROP, yuav muab ntxiv rau tus me
nyuam daim ntawv yug.
Ua tib zoo nyeem tag nrho daim ntawv no los sis hais kom leej twg nyeem rau koj. Yog tias koj tsis nkag siab ib
yam twg, tsis txhob kos npe rau thiab thov kev pab. Nrhiav lus teb rau koj cov lus nug ua ntej koj kos npe rau
daim ntawv no.
Yog koj yog tus uas xav tias yog leej txiv thiab koj xav xaus koj txoj kev sib txheeb ib tug me nyuam uas yug los
thaum neb tseem sib yuav los sis hauv 280 hnub tom qab koj nrauj tus me nyuam leej niam lawm:
• Teev ntawv rau txhua yam uas thov qhia hauv daim no
• Siv tej npe thiab xov xwm uas yuav phim tus me nyuam daim ntawv yug
• Thov kom tau ib daim tshiab yog tias koj sau yuam kev. Tsis txhob sau ib kab ntawv dhau plaws tej lo lus los
sis muab kho li ca
• Kos npe rau daim ntawv no rau ntawm ib tug neeg nias thwj ua tim khawv
• Teev daim ntawv thim tawm nrog rau Minnesota Tuam Tsev rau Kev Noj Qab Nyob Zoo ua ntej dhau ib
xyoos tom qab tus me nyuam yug los.
Xa duab fax txog daim no uas ua tiav mus rau 651-215-5834.
Yog tias koj tsis muaj cuab kav xa duab fax, ces xa daim no tuaj rau:
(Minnesota Tuam Tsev rau Kev Noj Qab Nyob Zoo)
(Hoob Kas rau Ntaub Ntawv Tseem Ceeb)
Minnesota Department of Health
Office of Vital Records
PO Box 64499
St. Paul, MN 55164-0499
Yog tias koj tsis nkag siab ib yam twg hauv daim ntawv no, thov kev pab.
Kom tau cov xov xwm sau ua lwm hom ntawv, thov koj
tus neeg ua hauj lwm hauv lub nras. Kom tau kev pab
rau lwm yam kev txais kev pab tib neeg yam sib txig, hu
koj lub nras tus Neeg Saib Xyuas ADA (Txoj Cai hais txog
Neeg Amelikas Xiam Hoob Khab).
ADA4 (2-18)
Lwv Daim Ntawv
DHS-3159C-HMN 6-18
Minnesota Kev Txaus Siab Lees Paub Txog Kev Ua Leej Niam Leej
Txiv Tus Khub Nqe Lus Tsis Lees Tias Yog Leej Txiv
Raws li sau hauv Minnesota Txoj Kev Cai, kem 257.75, tshooj 1a, Kuv
,
(TUS TXIV LUB NPE, NPE NRAB, LUB XEEM)
lees thiab hais tias, txawm tias tus me nyuam uas muaj npe hauv qab yog yug thaum lub sij hawm uas kuv yuav leej niam los yog hauv
280 hnub tom qab wb sib nrauj tas los, kuv tsis yog leej txiv yug ntawm:
LUB NPE
NPE NRAB
LUB XEEM
NTAWV CIM TOM QAB LUB NPE (Jr., Sr., I, II, thiab ntxiv)
POJ NIAM/TXIV NEEJ
HNUB YUG
Txiv neej
Poj niam
LUB TSEV KHO MOB NPE LOS YOG QHOV CHAW YUG (yog hais tias tsis yog tim tsev kho mob)
NROOG
XEEV
TEB CHAWS
LUB NPE
NPE NRAB
LUB XEEM
NTAWV CIM TOM QAB LUB NPE (Jr., Sr., I, II, thiab ntxiv)
HNUB YUG (hli/hnub/xyoo)
ZAUV XOV TOOJ
CHAW XA NTAWV
NROOG
XEEV
ZAUV CHEEB TSAM
TEB CHAWS
LUB NPE
NPE NRAB
LUB XEEM
NTAWV CIM TOM QAB LUB NPE (Jr., Sr., I, II, thiab ntxiv)
HNUB YUG (hli/hnub/xyoo)
ZAUV XOV TOOJ
CHAW XA NTAWV
NROOG
XEEV
ZAUV CHEEB TSAM
TEB CHAWS
Tus me nyuam leej niam thiab kuv sib yuav rau thaum
, hauv
(HLI/HNUB/XYOO)
,
,
.
(NROOG)
(XEEV)
(TEB CHAWS)
Kuv paub tias lwm tus txiv neej uas tau kos npe los yog yuav kos npe rau daim Kev Lees Paub Txog Kev Ua Leej Niam Leej Txiv yog
leej txiv yug ntawm tus me nyuam uas muaj npe saud.
Kuv nkag siab tias:
Tus khub kos npe x________________________________
• Yog hais tias siv tau daim no hauv cov ntaub ntawv, kuv lub npe
yuav tsis nyob hauv tus me nyuam uas muaj npe saud daim ntawv
In the state of _________________, County of_____________________
yug los yog tus me nyuam daim ntawv yug yuav muab kho kom
Signed and sworn/affirmed to before me this (mm/dd/yy):
muaj leej txiv yug lub npe rau hauv.
• Yog yuav thim tawm daim ntawv no, hauv 60 hnub tom qab kos
/
/
npe tas, kuv yuav tsum tau sau ntawv tuaj qhia tias kuv thim tawm
daim no; kos npe rau daim ntawv thim tawm tim ntsej tim muag
ntawm ib tug neeg nias thwj uas tim khawv; thiab teev daim ntawv
thim tawm nrog rau Minnesota Tuam Tsev Pab Txog Txoj Kev Noj
Qab Haus Huv uas xa duab fax los yog xa hauv kev xa ntawv mus.
• Yog hais tias kuv tsis thim tawm daim ntawv no uas lawv txais hauv
cov ntaub ntawv, yuav siv tau tshwj tsis yog tias thim tawm daim
_________________________________
_____________________
ROP los yog tsev hais plaub muab ib daim ntawv txib tias siv tsis tau
Notary Public Signature
My commission expires
daim ROP.
• Thaum kos npe rau thiab teev daim ntawv no kuv thiaj zam tag
Form completed at:
nrho kuv cov cai hais tias kuv yog leej txiv yug rau tus me nyuam
Hospital
MDH
DHS
County
saum toj no uas tau yug los thaum kuv yuav nws niam uas kuv tus
poj niam los sis hauv 280 hnub tom qab wb sib nrauj. Tshaj tawm:
Agency
Other
yog hais tias thim tawm daim ROP los yog tsev hais plaub txib tias
AGENCY NAME:
siv tsis tau, daim SNPS yuav siv tsis tau thiab yuav suav tias kuv yog
tus neeg uas ntseeg tias yog leej txiv ntawm rau tus me nyuam no.
AGENCY PHONE:
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