The Mississippi Acknowledgement of Paternity form, known as Form 564, lets an unmarried father establish legal parentage without going to court. Both parents complete the form, sign it in front of a notary, and submit it with a $28 fee to the Mississippi State Department of Health. Once accepted, the father’s name is added to the child’s birth certificate and the legal parent-child relationship carries the same weight as if the parents had been married at the time of birth.1Justia. Mississippi Code 93-9-28 – Procedures for Voluntary Acknowledgement of Paternity
Who Can Use Form 564
The form is only available when the mother was unmarried for the entire period between conception and birth. Its instructions say so directly: it “cannot be used for paternity acknowledgement if the mother is married or was married at any time between the conception and birth of this child.”2Mississippi State Department of Health. Acknowledgement of Paternity (Form 564) If the mother was married to someone else during that window, Mississippi law presumes her husband is the father, and establishing a different man’s paternity requires a court proceeding.
Both parents must sign voluntarily. Neither can be pressured or coerced, and both should understand before signing that the acknowledgment has the same legal force as a court order of paternity.1Justia. Mississippi Code 93-9-28 – Procedures for Voluntary Acknowledgement of Paternity
Information You’ll Need
Every field on the form must be completed, so gather the details before you start.
For the child, you’ll need the full name (first, middle, last), the date of birth, and the county of birth.
For the father, the form asks for:
- Full name
- Race and Hispanic origin (checkboxes)
- Date and state of birth
- Social Security number
- Education level
- Current residence: state, county, city or town, and street address
The Social Security number is required by state law, which directs the Department of Health to collect it from both parents.1Justia. Mississippi Code 93-9-28 – Procedures for Voluntary Acknowledgement of Paternity
If the mother’s name has changed since the birth certificate was filed, through marriage, court order, or otherwise, include documentation of that change so the Department of Health can reconcile the notarized signature with the name already on file.2Mississippi State Department of Health. Acknowledgement of Paternity (Form 564)
Where to Get the Form
Mississippi hospitals and birthing centers are required to offer both parents the chance to complete the acknowledgment at the time of birth.1Justia. Mississippi Code 93-9-28 – Procedures for Voluntary Acknowledgement of Paternity If you don’t do it then, you can download Form 564 in English or Spanish from the Mississippi State Department of Health’s website,3Mississippi State Department of Health. Forms or pick one up at the Vital Records office in Ridgeland.
Getting the Form Notarized
Both signatures must be notarized. The form states that it “must be signed and sealed by a Notary Public.”2Mississippi State Department of Health. Acknowledgement of Paternity (Form 564) The notary verifies each signer’s identity and confirms they are signing willingly. Many hospitals keep notaries on staff for exactly this purpose. If you’re completing the form after leaving the hospital, any licensed notary public can perform the service.
Filing the Form and Paying the Fee
Mail the completed, notarized form to:
Mississippi State Department of Health
Vital Records
Post Office Box 1700
Jackson, Mississippi 39215-1700
You can also deliver it in person to the Vital Records office at 222 Marketridge Drive in Ridgeland, open Monday through Friday from 8:00 a.m. to 4:00 p.m.4Mississippi State Department of Health. Vital Records
Include a $28 fee, which covers processing and one certified copy of the amended birth certificate. Payment can be made by personal check, money order, bank check, or cashier’s check. Cash is not accepted.5Mississippi State Department of Health. Affidavit to Amend Mississippi Certificate of Live Birth Additional certified copies of the birth certificate are $6 each.6Mississippi State Department of Health. Birth Certificates
Your package should include three items: the completed form, any supporting documents such as proof of a name change, and the $28 payment.2Mississippi State Department of Health. Acknowledgement of Paternity (Form 564) Questions can be directed to the Vital Records Amendments Department at 601-206-8200 or VRInfo@msdh.ms.gov.4Mississippi State Department of Health. Vital Records
What Changes Once the Form Is Accepted
After the Bureau of Vital Statistics reviews and accepts the form, the father’s information is added to the child’s birth certificate. One consequence catches many parents off guard: Mississippi law automatically changes the child’s surname to the father’s last name, unless both parents filed an affidavit at birth requesting a different surname.7FindLaw. Mississippi Code Title 41 Public Health 41-57-23
Because the acknowledgment carries the same legal weight as marriage at the time of birth, the father gains the right to seek custody or visitation, and either parent can petition a court for child support.1Justia. Mississippi Code 93-9-28 – Procedures for Voluntary Acknowledgement of Paternity The Department of Health may share the acknowledgment with the Division of Child Support Enforcement at the Mississippi Department of Human Services.
Your Right to Cancel Within One Year
Either parent can rescind the acknowledgment within one year of signing, with no reason required. The exact deadline is the earlier of one year from the signing date or the date a court proceeding involving the child begins, such as a child support hearing.1Justia. Mississippi Code 93-9-28 – Procedures for Voluntary Acknowledgement of Paternity
To rescind, complete a Rescission of Acknowledgement of Paternity form and file it with the Bureau of Vital Statistics. You must sign the rescission in the same manner as your original signature, and it must be notarized.8Legal Information Institute. Mississippi Administrative Code 15-5-85-3.18.2 – Rescission of Acknowledgement of Paternity Either the mother or the father can file it.9Mississippi State Department of Health. Questions and Answers About Vital Records
The father has one additional protection during this window. He can request genetic testing through the Mississippi Department of Human Services, and once he files a formal application for testing, the one-year clock pauses from the application date until the results come back.1Justia. Mississippi Code 93-9-28 – Procedures for Voluntary Acknowledgement of Paternity
After the one-year window closes, undoing the acknowledgment is much harder. A challenge is only possible through a court proceeding on narrow grounds of fraud, duress, or material mistake of fact, and the person bringing the challenge carries the burden of proof.10Justia. Mississippi Code 93-9-9 – Enforcement; Attorneys Fees Child support and other obligations keep running while the challenge is pending unless a court suspends them for good cause.
Think About Genetic Testing Before You Sign
The form itself warns the father about his right to request genetic testing and the “adverse effects and ramifications of not availing himself of this one-time opportunity.”1Justia. Mississippi Code 93-9-28 – Procedures for Voluntary Acknowledgement of Paternity Once you sign and the rescission period passes, you are legally the child’s father regardless of biology, and child support obligations and inheritance rights are locked in.
If there is any doubt about biological paternity, request a test through the Mississippi Department of Human Services before signing or within the one-year window afterward. A father who signs and later learns he is not the biological parent faces a difficult legal fight to undo the acknowledgment, and courts are not required to pause his financial obligations while the case is sorted out.