Missouri DHSS - Vital Records Applications and Forms · Missouri state form

MO 580-2958 Mother’s Affidavit Acknowledging Paternity

The mother completes this affidavit to acknowledge a child’s paternity and request that the father’s information be added to the child’s birth record.

What this form is

This affidavit collects information about the mother, father, and child and records the mother’s acknowledgment of paternity. The mother may also use it to request a change to the child’s last name. The affidavit must be signed before a notary public or two witnesses. It must be submitted with the father’s affidavit and, if applicable, the Husband’s Denial of Paternity form.

Who needs it

A mother completing an acknowledgment of paternity and requesting that the father’s information be added to her child’s birth record needs this affidavit.

Why it needs a notary

The mother must sign before a notary public or two witnesses. If using a notary, this can be done online with a commissioned online notary.

How to submit it

Submit this affidavit together with the Father’s Affidavit Acknowledging Paternity and, if applicable, the Husband’s Denial of Paternity. If not completed at the hospital, send all completed affidavits to the address printed on the form.