Get Missouri Putative Father 2021-2025

MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES REQUEST FOR SEARCH OF PUTATIVE FATHER REGISTRY Forward original request to BUREAU OF VITAL RECORDS P. O. BOX 570 JEFFERSON CITY MO 65102-0570 Section 192. 016 RSMo requires the Missouri Department of Health and Senior Services to establish a putative father registry which allows a father of an out-of-wedlock child to file a notice of intent to claim paternity. Upon request the Department is to provide the names and addresses of persons listed with the registry to any court or authorized agency or entity or person named in section 453. 014 RSMo. Those named in section 453. 014 RSMo include 1 The Division of Family Services of the Department of Social Services 2 A child placing agency licensed pursuant to section 210. 481 to 210. 536 RSMo 3 The child s parents without the direct or indirect assistance of an intermediary in the home of a relative of the child within the third degree 4 An intermediary who shall include an attorney licensed pursuant to chapter 484 RSMo a physician licensed pursuant to Chapter 334 RSMo or a clergyman of the parents. The information shall not be divulged to any other person except upon order of a court for good cause shown* PLEASE PRINT OR TYPE SECTION ONE - COMPLETED BY REQUESTING AGENT CHILD S INFORMATION CHILD S NAME FIRST MIDDLE LAST DATE OF BIRTH MONTH/DAY/YEAR PLACE OF BIRTH CITY COUNTY STATE HOSPITAL OF BIRTH MOTHER S INFORMATION NAME FIRST MIDDLE LAST MAIDEN AUTHORIZED AGENCY ENTITY OR PERSON NAME OF REQUESTING AGENCY AGENCY CAUSE NO. TITLE OF AGENT SIGNATURE OF AGENT ENTITY OR PERSON DATE IF RELATIVE HOW RELATED SPECIFY MOTHER FATHER BROTHER SISTER GRANDMOTHER GRANDFATHER IF INTERMEDIARY CHECK ONE LICENSED ATTORNEY LICENSED PHYSICIAN CURRENT MAILING ADDRESS STREET CITY STATE ZIP CODE CLERGY OF THE PARENT TELEPHONE NUMBER A NOTICE OF INTENT TO CLAIM PATERNITY FILED WITH BUREAU Yes No A FATHER S NAME APPEARS ON THE REGISTRY ADDED BY COURT ORDER ADDED BY AFFIDAVIT ACKNOWLEDGING PATERNITY DATE A NOTICE OF INTENT WAS FILED WITH THE BUREAU MONTH/DAY/YEAR ADDED BY DSS ORDER DATE CHANGE OF ADDRESS WAS REGISTERED MONTH/DAY/YEAR INFORMATION ON REGISTRY CURRENT ADDRESS STREET CITY STATE ZIP CODE MO 580-2223 6-12 VS-421. Upon request the Department is to provide the names and addresses of persons listed with the registry to any court or authorized agency or entity or person named in section 453. 014 RSMo. Those named in section 453. 014 RSMo include 1 The Division of Family Services of the Department of Social Services 2 A child placing agency licensed pursuant to section 210. 014 RSMo. Those named in section 453. 014 RSMo include 1 The Division of Family Services of the Department of Social Services 2 A child placing agency licensed pursuant to section 210. 481 to 210. 536 RSMo 3 The child s parents without the direct or indirect assistance of an intermediary in the home of a relative of the child within the third degree 4 An intermediary who shall include an attorney licensed pursuant to chapter 484 RSMo a physician licensed pursuant to Chapter 334 RSMo or a clergyman of the parents.