Form DCH-0848 "Application to Add a Father on a Michigan Birth Record" - Michigan

What Is Form DCH-0848?

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

Form Details:

  • Released on August 1, 2021;
  • The latest edition provided by the Michigan Department of Health and 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 printable version of Form DCH-0848 by clicking the link below or browse more documents and templates provided by the Michigan Department of Health and Human Services.

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Download Form DCH-0848 "Application to Add a Father on a Michigan Birth Record" - Michigan

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APPLICATION TO ADD A FATHER ON A MICHIGAN BIRTH RECORD
Michigan Department of Health and Human Services
(This form is to be used to add a father only - not to replace or remove a father previously named)
MAIL APPLICATION AND PROPER FEE TO:
For additional information:
517-335-8660
Vital Records Changes
www.Michigan.gov/VitalRecords
P.O. Box 30721
Lansing MI 48909
APPLICANT (PERSON REQUESTING CHANGE OR CORRECTION)
PLEASE PRINT CLEARLY AND LEGIBLY
Applicant’s
Name:
Address:
(Cannot send to General Delivery)
City/State:
Zip:
Notifications by email?
Yes
No
Daytime Phone Required: (
)
Email Address:
PHOTO IDENTIFICATION must be presented along with this application and payment. (See back for details)
ELIGIBILITY
To be eligible to add a father to a birth record, you must be one of the following. Please check the item that applies to you.
□ Person named on the record (Must be at least 18 years old or legally emancipated)
□ Legal guardian of the person(s) named or to be named on the record (Must include a copy of the court guardianship documents)
□ Parent named or to be named on the record
□ Legal licensed representative of the person(s) named or to be named on the record must provide information on official letterhead
documenting that he/she represents the person named on the record, and provide pictured ID for themselves, as well as ID for the client
REQUIRED DOCUMENTATION
Please check the appropriate box below for required documentation submitted.
□ An original signed/notarized Affidavit of Parentage is attached with the application.
□ A court order is attached (Order of filiation or court determination of paternity)
□ Affidavit of Parentage has already been duly signed and notarized and has been submitted to the Central Paternity Registry.
□ A paternity acknowledgment that was filed before June 1, 1997. A true or certified copy from the probate court must be attached.
Affidavit of Parentage can be printed off our website or contact the Changes Unit at 517-335-8660 to request that one be mailed to you
INFORMATION NEEDED TO LOCATE CHILD’S BIRTH RECORD
If any birth information is unknown, please indicate “unknown”
STATE FILE NUMBER (If known)
GENDER
CHILD’S Date of Birth
CHILD’S
(mm/dd/yyyy)
Male
NAME AT
BIRTH
Female
First
Middle
Last
CHILD’S PLACE
OF BIRTH
Hospital
City
County
MOTHER’S NAME
FATHER’S
BEFORE
NAME
FIRST MARRIED
First
Middle
Last
First
Middle
Last
INDICATE FATHER’S FULL NAME AND INFORMATION TO BE ADDED
FATHER’S FULL NAME
First
Middle
Last
FATHER’S PLACE
FATHER’S DATE
OF BIRTH
OF BIRTH
State or Country (if not US)
Month
Day
Year
FATHER’S SOCIAL SECURITY NUMBER:
-
-
APPLICATION TO ADD A FATHER ON A MICHIGAN BIRTH RECORD
Michigan Department of Health and Human Services
(This form is to be used to add a father only - not to replace or remove a father previously named)
MAIL APPLICATION AND PROPER FEE TO:
For additional information:
517-335-8660
Vital Records Changes
www.Michigan.gov/VitalRecords
P.O. Box 30721
Lansing MI 48909
APPLICANT (PERSON REQUESTING CHANGE OR CORRECTION)
PLEASE PRINT CLEARLY AND LEGIBLY
Applicant’s
Name:
Address:
(Cannot send to General Delivery)
City/State:
Zip:
Notifications by email?
Yes
No
Daytime Phone Required: (
)
Email Address:
PHOTO IDENTIFICATION must be presented along with this application and payment. (See back for details)
ELIGIBILITY
To be eligible to add a father to a birth record, you must be one of the following. Please check the item that applies to you.
□ Person named on the record (Must be at least 18 years old or legally emancipated)
□ Legal guardian of the person(s) named or to be named on the record (Must include a copy of the court guardianship documents)
□ Parent named or to be named on the record
□ Legal licensed representative of the person(s) named or to be named on the record must provide information on official letterhead
documenting that he/she represents the person named on the record, and provide pictured ID for themselves, as well as ID for the client
REQUIRED DOCUMENTATION
Please check the appropriate box below for required documentation submitted.
□ An original signed/notarized Affidavit of Parentage is attached with the application.
□ A court order is attached (Order of filiation or court determination of paternity)
□ Affidavit of Parentage has already been duly signed and notarized and has been submitted to the Central Paternity Registry.
□ A paternity acknowledgment that was filed before June 1, 1997. A true or certified copy from the probate court must be attached.
Affidavit of Parentage can be printed off our website or contact the Changes Unit at 517-335-8660 to request that one be mailed to you
INFORMATION NEEDED TO LOCATE CHILD’S BIRTH RECORD
If any birth information is unknown, please indicate “unknown”
STATE FILE NUMBER (If known)
GENDER
CHILD’S Date of Birth
CHILD’S
(mm/dd/yyyy)
Male
NAME AT
BIRTH
Female
First
Middle
Last
CHILD’S PLACE
OF BIRTH
Hospital
City
County
MOTHER’S NAME
FATHER’S
BEFORE
NAME
FIRST MARRIED
First
Middle
Last
First
Middle
Last
INDICATE FATHER’S FULL NAME AND INFORMATION TO BE ADDED
FATHER’S FULL NAME
First
Middle
Last
FATHER’S PLACE
FATHER’S DATE
OF BIRTH
OF BIRTH
State or Country (if not US)
Month
Day
Year
FATHER’S SOCIAL SECURITY NUMBER:
-
-
TO CHANGE THE CHILD’S NAME OR TO CHANGE THE MOTHER’S NAME DUE TO MARRIAGE
If there is any change in the child’s name from that originally recorded on the birth record, please indicate the name change below.
Please indicate if the mother of the child wishes to have her name changed due to marriage to the biological father.
CHILD’S FULL NAME AT BIRTH
First
Middle
Last
CHILD’S FULL NAME AS YOU WANT IT TO
APPEAR ON THE NEW BIRTH RECORD
First
Middle
Last
Do you wish to change mother’s name on
If yes,
YES
the record due to marriage? (Copy of
indicate
NO
marriage certificate must be submitted)
name here
First
Middle
Last
THE SIGNATURE OF AN ELIGIBLE APPLICANT IS REQUIRED TO PROCESS THIS APPLICATION.
If the court order specifies a new name for the child, only the applicant’s signature and copy of legal ID is required. If the court order does
not specify a new name for the child, both parents’ signatures and legal IDs are required when requesting a name change for the child. If
the child is over 15 and you are changing the child’s name, we also require the child’s signature.
Applicant/Parent’s Signature
Date
Parents’ Signature
Date
PHOTO ID REQUIREMENTS FOR CHANGING OR
PHOTO ID REQUIREMENTS
CORRECTING A MICHIGAN BIRTH RECORD
(CONTINUED)
*Please Send Photocopies – Not Original Documents*
Under Michigan law, birth records are restricted documents. To request a birth
record, a current valid, government issued identification is required to establish
--OR (If you do not have documents from Tier 1 or 2)
eligibility (except for an unrestricted birth record that is at least 100 years old).
To protect from identity theft, a copy of the applicant’s government issued
Tier 3 Documentation must include at least three alternative documents of
identification must be presented along with the application and fees.
different types from the list below, one must have been issued within the
past year:
Tier 1 Documentation that establishes identity by itself.
 Any of the documents in Tier 1 expired more than 5 years.
 U.S. or Foreign Passport or Passport Card
 Social Security Card (must be signed)
 U.S. or U.S. Territories Driver’s License or Identification Card
 Marriage or Divorce certificate
 U.S. Military Identification Card with both picture and signature
 Your child’s birth certificate
 Other U.S. or U.S. Territories issued document that meets the following
 IRS form W-2
criteria: Document must be unexpired. Document must contain a
 Paycheck stub, Bank statement
photograph and at least the following information: name, date of birth,
 Voter registration
date of expiration, signature, and address.
 Motor vehicle registration
--OR (If you do not have a document from Tier 1)
 Health insurance card, Doctor/hospital/dentist bill
Tier 2 Documentation must include all documentation in one of the
 Utility Bill
categories below:
 Religious/community organization documents, baptismal certificate
 Any of the documents in Tier 1 that expired within the past 5 years and
 Military DD-214 discharge paper or equivalent
any one document from Tier 3 issued within the past year.
 School records
 Employment identification with photo, accompanied with a pay stub or W-
 Letter/benefit statement from a government agency, like SSA or IRS
2 form issued within the past year.
 Land or rental agreement
 Student identification with photo, accompanied by a current report card or
 Military ID with either a picture or signature.
other proof of current school enrollment. Both documents must be for the
 Other documents that establish identity to a degree equivalent to those
same institution.
listed above.
 Department of Corrections identification card accompanied by probation
or discharge papers issued within the past year.
 If an inmate is currently incarcerated, a Department of Corrections
identification card, accompanied by a verification of incarceration issued
within the past year.
PAYMENT - The fee for adding the father’s name and information to a
Application Fee (Non-Refundable) Fee
Michigan birth record is $50.00 and includes one copy of the record with the
includes one (1) certified copy of the record
changes made. Additional copies of the new record are available for $16.00
each when ordered at the same time. Payment must be made by check or
$ 50.00
$ 50.00
money order and made payable to the “State of Michigan.”
Additional Certified Copies
PROCESSING TIME – Normal processing time for all changes or
$ 16.00 Each
$
corrections is 5-6 weeks from the date all documentation, payments and
Rush Fee
photo ID are received in the State Vital Records Office and the order is
keyed into the system. 2-3-week rush processing is available for an
$ 25.00
$
additional fee.
PENALTIES: Any person who willfully and knowingly makes false application
to change or amend a Michigan birth record may be fined and/or imprisoned
TOTAL ENCLOSED
$
pursuant to MCL 333.2894(1)(b) and (c).
The Michigan Department of Health and Human Services (MDHHS) does
not discriminate against any individual or group because of race, religion,
age, national origin, color, height, weight, marital status, genetic
information, sex, sexual orientation, gender identity or expression, political
beliefs or disability.
DCH-0848 Rev. 8-2021 By Authority of MCL 333.2824(4), 333.2872(1) and 333.2891(9)
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