Putative Father Registry Search Form (JFS 1695)
Identifying Information About The Mother

Mother's LAST Name FIRST Name MIDDLE Name
Social Security Number Home Phone Number Cell/Pager Number
Work Phone Number Work Extension Number
Date Of Birth Race Email Address
RadDatePicker
RadDatePicker
Open the calendar popup.
select
Aliases
Command item
Command item
Add new recordRefresh
 Last NameFirst NameMiddle Name 
No records to display.
Addresses
Command item
Command item
Add new recordRefresh
 Address TypeStreet NumberDir. PreFixStreet NameDir. PostFixUnit TypeUnit NumberCityStateZipCodeZipExtCountry 
No records to display.

Identifying Information About The Father

Father's LAST Name FIRST Name MIDDLE Name
Social Security Number Home Phone Number Cell/Pager Number
Work Phone Number Work Extension Number
Date Of Birth Race Email Address
RadDatePicker
RadDatePicker
Open the calendar popup.
select
Aliases
Command item
Command item
Add new recordRefresh
 Last NameFirst NameMiddle Name 
No records to display.
Addresses
Command item
Command item
Add new recordRefresh
 Address TypeStreet NumberDir. PreFixStreet NameDir. PostFixUnit TypeUnit NumberCityStateZipCodeZipExtCountry 
No records to display.

Identifying Information About The Child

Child's LAST Name FIRST Name MIDDLE Name
Sex Race
select
Estimated Due Date of Mother Child's Date Of Birth
RadDatePicker
RadDatePicker
Open the calendar popup.
RadDatePicker
RadDatePicker
Open the calendar popup.
Child's Birthplace
City State
select
Hospital Name Country
select
Birth Ceritified Multiple Birth
Information About Interested Party Requesting Search Of Registry

Name Of Firm Or Agency
Name Of Person Requesting Search
Phone Number Extension Fax Number
Email Address
Type Of Requesting Search Person
select
Reason For Search Is:
select
Address For Notice of Search Results
Street # Dir. Prefix          Street Name Dir. Suffix Unit Type Unit #
select
 
select
select
City State          ZipCode  -  Ext Country
select
 - 
select
Submission Confirmation Language
Signature of Requestor  Date  
RadDatePicker
RadDatePicker
Open the calendar popup.