Missouri DHSS - Vital Records Applications and Forms · Missouri state form
Revocation of Notice of Intent to Claim Paternity MO 580-3371 / VS-422
Use this form to revoke a previously filed notice of intent to claim paternity and request that the revocation be registered with the Putative Father Registry.
- What this form is
- A father who previously filed a notice of intent to claim paternity may use this form to revoke that notice. The form collects information about the child, mother, and father, and includes a sworn statement of intent to revoke. The father must complete it in the presence of a notary and mail it to the Bureau of Vital Records at the address shown.
- Who needs it
- A father who has filed a notice of intent to claim paternity and wants to revoke that previously filed notice needs this form.
- Why it needs a notary
- The signature must be notarized. The form must be completed in the presence of a notary, and this can be done online with a commissioned online notary.
- How to submit it
- Mail the completed form to DHSS - Bureau of Vital Records, 930 Wildwood Dr., Jefferson City, MO 65109. Type or print entries except the signature, using black ink.
Questions
Who uses the Revocation of Notice of Intent to Claim Paternity form?
A father who previously filed a notice of intent to claim paternity may use this form to revoke that notice and request registration of the revocation.
Does this form need to be notarized?
Yes. The form says it must be signed in the father’s presence before a notary. The signature can be notarized online with a commissioned online notary.
Where do I mail the completed form?
Mail it to DHSS - Bureau of Vital Records, 930 Wildwood Dr., Jefferson City, MO 65109, as listed on the form.