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We acknowledge that we are the biological parents of the following child (Name of child as it appears on the birth certificate. First Middle Born in Last Sex (M/F) on (Place of Birth) City/Town State Social Security # Month - spelled out Day Year (Child's SSN - If available) We voluntarily sign this acknowledgement to establish the child's paternity. We understand that this acknowledgement may be used to amend the child's birth certificate and the names of both parents will be on.

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