Washington State Department of Health - Vital Records Forms · Washington state form
DOH 422-157 Rescission of Parentage (Spanish)
Spanish-language form for a person who signed an Acknowledgment or Denial of Parentage to rescind it and restore the child’s prior birth-record information.
- What this form is
- Use this form to rescind an Acknowledgment of Parentage or Denial of Parentage filed with the Department of Health. The form states that it must be filed within 60 days after the original filing or before the first court proceeding to determine parentage, whichever happens first. The signer must complete the required information and sign before either a notarial officer or a qualifying witness, not both.
- Who needs it
- A person who signed an Acknowledgment or Denial of Parentage and wants to rescind it within the period stated on the form may use this document.
- Why it needs a notary
- The signature must be witnessed by either a notarial officer or a qualifying witness, not both. Notarization can be completed online with a commissioned online notary.
- How to submit it
- Complete the form and mail it with a nonrefundable $18 check or money order payable to DOH to the Department of Health, Center for Health Statistics, PO Box 9709, Olympia, WA 98507.
Questions
Who can use the Rescission of Parentage form?
The form may be signed by a person who signed the Acknowledgment of Parentage or Denial of Parentage. It is used to rescind that filing and restore the child’s previous birth-record information.
Does this form need to be notarized?
The signer must sign before either a notarial officer or a qualifying witness, but not both. A commissioned online notary can notarize the signature online; the form also allows a qualifying witness.
How do I submit the completed form?
Mail the completed form with a nonrefundable $18 check or money order payable to DOH to the Department of Health, Center for Health Statistics, PO Box 9709, Olympia, WA 98507.