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

MO 580-3361 Mother’s Affidavit Acknowledging Paternity

This affidavit lets a mother acknowledge a child’s paternity and request that the father’s name and information be added to the child’s birth certificate.

What this form is

The mother completes this affidavit with information about the child, father, and herself, then affirms that the named man is the child’s biological father. The form also includes an optional request to change the child’s surname. Each parent must complete and sign their own affidavit; the father’s and mother’s affidavits, and the husband’s denial of paternity when applicable, must be submitted together.

Who needs it

A mother acknowledging paternity for a child’s birth record needs this affidavit, completed with the father’s affidavit and any applicable denial of paternity.

Why it needs a notary

The mother must sign before a notary or two eligible witnesses. A commissioned online notary can notarize the signature online; the parents or their relatives cannot serve as witnesses.

How to submit it

Submit all completed affidavits together to the address shown on the form. Do not send faxed or photocopied forms; the form says they will not be accepted.