Fillable REQUEST FOR A CERTIFIED COPY OF A FILED (California)

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REQUEST FOR A CERTIFIED COPY OF A FILED (California)

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ASKPOP@DCSS.CA.GOV
CALIFORNIA DEPARTMENT OF CHILD SUPPORT SERVICES
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
REQUEST FOR A CERTIFIED COPY OF A FILED
VOLUNTARY DECLARATION OF PARENTAGE (VDOP)
DCSS 0918 (01/01/2020)
This form is used by the parents or the child only. The requestor must complete and sign the sworn statement in
front of a notary public, and the notary public must notarize the sworn statement. If you have any questions,
contact a State Parentage Opportunity Program (POP) Analyst by calling (866) 249-0773 or by emailing
ASKPOP@DCSS.CA.GOV.
REQUEST TYPE*:
MAIL- Returned via USPS (
Select the number
of requested copies in the drop down menu below)
FAX - Faxed to number provided
APOSTILLE - Returned via USPS
Complete all known fields as they were input on the Voluntary Declaration of Parentage
Required fields are marked with
*
Child's First Name*
Child's Middle Name
Child's Last Name
*
Child's Date of Birth*
If mail is selected in request type, provide number of requested copies
Child's County of Birth
Birth Parent's First Name*
Birth Parent's Last Name
Birth Parent's DOB
Birth Parent's SSN
Other Parent's First Name Other Parent's Last Name
Other Parent's DOB
Other Parent's SSN
Required Requestor Information
Phone Number - Direct Line*
Requestor's First and Last Name*
Requestor Fax*
Requestor*
Parent
Child
Requestor's complete Mailing Address including Unit/Apartment Number, City, State and Zip Code*
RECORD VERIFICATION
For State Use Only
VDOP on File No VDOP on File
Date Parentage Established:
POP Analyst / Processed Date
:
Page 1 of 3
Requestor's email address:
SELECT NUMBER OF COPIES (1-9)
SELECT ONE COUNTY
PRIVACY NOTICE
The Information Practices Act of 1977 (Civil Code §1798.17) and the Federal Privacy Act of 1974 (Title 5,
United States Code §552a(e)(3)) require that this notice be provided when collecting personal information
from individuals. Information requested on this form is used by the Department of Child Support Services
and local child support agencies for the purpose of safeguarding information from disclosure in domestic
and/or child abuse situations. The information you provide may be given to the federal government, and
other public agencies to the extent required by law. Failure to provide this information will limit the DCSS’
ability to safeguard your information.
The agency officially responsible for maintenance of the form is the State Coordinator at the Parentage
Opportunity Program (POP) of the Department of Child Support Services (DCSS). Legal references
authorizing solicitation and maintenance of the personal information include Title 42, United States Code
§6669(a)(13) and Family Code §7571. Copies of this form are maintained in confidential files of the State
Coordinator at the Parentage Opportunity Program (POP) of the Department of Child Support Services
(DCSS). Declarants have the right of access to their filed form(s) upon request by calling (866) 249-0773.
PROCESSING INFORMATION
Mailed Requests:
o Mail written request to:
California Department of Child Support Services
Pa
rentage Opport
unity Program
P.O. Box 419070
Rancho Cordova, CA 95741-9070
o
Processed within 5 business days upon receipt
o
Returned via United States Postal Service (USPS) only
Fax Requests:
o Fax request to: (
916)
464-5898
o
Processed within 5 business days upon receipt
o Returned via fax to the fax number provided by requestor
Apostille Requests:
o Processed within 5 business days upon receipt
o Returned via United States Postal Service (USPS) only
DECLARATION
I am the p
arent or child identified on this p
arent/child request (DCSS 0918) form and am submitting
to the Department of Child Support Services, Parentage Opportunity Program (POP). I declare
under the penalty of perjury under the laws of the State of California that I am authorized under
Family Code §7571(i)) to receive this information.
Page 2 of 3
CALIFORNIA DEPARTMENT OF CHILD SUPPORT SERVICES
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
REQUEST FOR A CERTIFIED COPY OF A FILED
VOLUNTARY DECLARATION OF PARENTAGE (VDOP)
DCSS 0918 (01/01/2020)
SWORN STATEMENT
I, ___________________________________, declare under penalty of perjury under the laws of the State of California, that I
(Applicant's Printed Name)
am an authorized person, as defined in California Family Code section 7571(i), and am eligible to receive a certified copy of
the filed Voluntary Declaration of Parentage of the following individual(s):
Name of Child Listed on
Voluntary D
eclaration of Parentage
Name of Parents Listed on Voluntary Declaration of Parentage
(Must be a relationship identified in California Family Code §7571(i))
Subscribed to this ______ day of ______________, 20___, at ________________________________, _____________.
(Day) (Month) (City) (State)
______________________________________________________
(Applicant's Signature)
Note: In order for the Parentage Opportunity Program (POP) to process a request for a certified copy of a filed Voluntary
Declaration of Parentage form, the Sworn Statement must be notarized using the Certificate of Acknowledgment below. The
Certificate of Acknowledgment must be completed by a Notary Public. (Law enforcement and local and state governmental
agencies are exempt from the notary requirement.) Only one sworn statement is required for multiple records.
(The remaining information must be completed in the presence of a Notary Public.)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
CERTIFICATE OF ACKNOWLEDGMENT
A notary public or other officer completing this certificate verifies only the
identity of the individual who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or validity of that document.
that the foregoing paragraph is true and correct.
I certify under PENALTY OF PERJURY under the laws of the State of
WITNESS my hand and official seal.
Signature___________________________________________
(Seal)
Page 3 of 3
Califor
nia
County of________________________________)
On ___________________before me, _________________________________,
(insert name and title of the officer)
personally appeared __________________________________,
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument
and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
State of California
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REQUEST FOR A CERTIFIED COPY OF A FILED (California)

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Completed 1 June 2021

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