Get Request Name Father Child Out 2017-2024

LDSS-2725 Rev. 12/2017 NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES REQUEST/RESPONSE FOR NAME AND/OR ADDRESS OF FATHER OF CHILD BORN OUT OF WEDLOCK Print or type all information REQUEST DATE FORWARD ORIGINALS TO New York State Office of Children and Family Services OCFS Putative Father Registry / REQUEST - Please one form per child REQUESTING AGENCY/COURT Name and Address Required SIGNATURE OF AGENCY/COURT OFFICIAL OCFS upon request will provide the names and addresses of persons listed with the registry to any New York State authorized agency or court and such information shall not be divulged to any other person except upon order of the court for good cause shown. Social Services Law 372-c Putative Father Registry. PRINT NAME OF AGENCY/COURT OFFICIAL AGENCY/COURT TEL* include Area Code FATHER S NAME FATHER S SOCIAL SECURITY If known CHILD S NAME CHILD S DATE OF BIRTH INSTRUCTIONS 1. COMPLETE ALL THE BOXES ABOVE* If you complete this form online print and then sign the form* If you complete a hard copy please print neatly and sign in the AGENCY/COURT OFFICIAL box. 2. IF THE MOTHER DOES NOT NAME THE FATHER IN ANY AFFIDAVIT OR IF THE FATHER S NAME DOES NOT APPEAR ON THE CHILD S BIRTH CERTIFICATE LIST THE FATHER S NAME AS UNKNOWN* 3. MAIL ONLY ONE 1 COPY TO New York State Office of Children and Family Services NYSAS/Putative Father Registry 52 Washington Street Room 332 North Rensselaer NY 12144 OCFS Use Only Do not write below this line RESPONSE Not Registered STAFF INITIALS RESPONSE DATE REGISTRY INFORMATION DOCUMENT TYPE Acknowledgement of Paternity Notice of Intent to Claim Paternity Court Order PUTATIVE FATHER S NAME Instrument to Acknowledge Paternity DATE OF BIRTH SOCIAL SECURITY NUMBER ADDRESS DATE OF COURT ORDER DOCKET NUMBER COURT DATE REGISTERED. PRINT NAME OF AGENCY/COURT OFFICIAL AGENCY/COURT TEL* include Area Code FATHER S NAME FATHER S SOCIAL SECURITY If known CHILD S NAME CHILD S DATE OF BIRTH INSTRUCTIONS 1. COMPLETE ALL THE BOXES ABOVE* If you complete this form online print and then sign the form* If you complete a hard copy please print neatly and sign in the AGENCY/COURT OFFICIAL box. COMPLETE ALL THE BOXES ABOVE* If you complete this form online print and then sign the form* If you complete a hard copy please print neatly and sign in the AGENCY/COURT OFFICIAL box. 2. IF THE MOTHER DOES NOT NAME THE FATHER IN ANY AFFIDAVIT OR IF THE FATHER S NAME DOES NOT APPEAR ON THE CHILD S BIRTH CERTIFICATE LIST THE FATHER S NAME AS UNKNOWN* 3. 2. IF THE MOTHER DOES NOT NAME THE FATHER IN ANY AFFIDAVIT OR IF THE FATHER S NAME DOES NOT APPEAR ON THE CHILD S BIRTH CERTIFICATE LIST THE FATHER S NAME AS UNKNOWN* 3. MAIL ONLY ONE 1 COPY TO New York State Office of Children and Family Services NYSAS/Putative Father Registry 52 Washington Street Room 332 North Rensselaer NY 12144 OCFS Use Only Do not write below this line RESPONSE Not Registered STAFF INITIALS RESPONSE DATE REGISTRY INFORMATION DOCUMENT TYPE Acknowledgement of Paternity Notice of Intent to Claim Paternity Court Order PUTATIVE FATHER S NAME Instrument to Acknowledge Paternity DATE OF BIRTH SOCIAL SECURITY NUMBER ADDRESS DATE OF COURT ORDER DOCKET NUMBER COURT DATE REGISTERED. .