However, if sixty days have not yet passed, a rescission form may be submitted by either signer of the original paternity affidavit. The procedure for removing a father’s name from a birth record requires a court order, unless it is done within sixty days of the date that the paternity affidavit naming that individual as the father was filled out. If a court order is required, an attorney is generally needed. Both sides of this form must be notarized by a notary public. Parents can come in person to the Arkansas Department of Health at 4815 West Markham, Slot 44, Little Rock, AR 72205, or they submit a request that the form and instructions be mailed to them via phone (50), fax (50), or email they can obtain the form from any hospital’s medical records department and return it completed, along with payment, by mail to the Arkansas Department of Health at the address above. Office hours for the Arkansas Department of Health are Monday through Friday, 8:00am to 4:30pm, with the exception of state holidays, when the office is closed. If the mother was married to another man during the child’s conception or birth and there is no father listed on the child’s certificate, a three-way paternity affidavit can be filled out. The mother and husband/ex-husband will sign the back of the form and the mother and biological father will sign the front of the form. If the mother was married to another man during the child’s conception or birth:Ī court order will be required in order to make any changes to the record. Normally an attorney is needed for this type of action.
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