Department of Children’s Services

INSTRUCTIONS FOR USE OF FORM

CS-0435

To print this form without instructions:

Select File; Print; Click to select “Pages” and type “S2” (for “Section 2”), then select “OK.” Form will print only the pages of the form (numbered 1, 2, 3) and not the instructions page(s) (numbered i, ii, iii). To print only the instructions, do the same as above butselect “Pages” and type “S1” (for “Section 1”), then select “OK.”

Authorized individuals seeking information available through the Putative Father Registry will complete and file one copy of the Request for Name and/or Address of Father with Claim of Paternity. The document may be printed or typed. One document is completed for each child and each father, including “unknown” if appropriate.

Request Date: Enter the date that the request is issued.

Requesting Party Name/Address/Telephone/Fax/Email Address: Enter the name of the person who is requesting the information and if appropriate, their title and the agency or organization who they are representing. Enter the full mailing address for the requestor including street, P.O. Box # Suite, City, State and Zip Code. Enter the telephone contact number for the requestor and the fax number for the requestor. Enter the email address of the requestor to whom the response will be returned by secure email.

Reason for Request: Enter a reason for this request from the following list: TPR and/or Adoption, or Child Support or Medical Support. The Putative Father Registry is not appropriate for diligent search if termination or adoption is not being sought.

Child’s Birth Name: Enter the child’s birth name including first and last names. If possible, identify middle name or middle initial.

Place of Birth (City, County and State): Enter the city, and county and the State of the child’s birth.

Sex of Child: Check the appropriate designation for the sex of the child.

Child’s Birth Date: Enter the month, day and year of the child’s birth date.

Father’s Name: Enter nameof birth father including “Unknown” if appropriate.

Mother’s Name: Enter the current name of the birth mother.

Mother’s Maiden Name: Enter the maiden name of the birth mother.

Forward one copy of the document by mail to:

Putative Father Registry—Attn: Registrar

Tennessee Department of Children’s Services

436 6th Avenue North

Nashville, TN 37243-1290

OR fax one copy of the completed document to Putative Father Registry, 615-532-6495.

Maintain a copy in your record.

The Putative Father Registry requests should be filed at least 10 days in advance of the need for a written response. The Tennessee Department of Children’s Services Putative Father review is a partnership between the TN DCS and TN Dept. of Health-Vital Statistics Registry. Every attempt will be made to return a response within that 10 day time frame subject to access to all systems and to state government schedules. If any emergency arises which limits the 10 days, the Office of the Putative Father Registry will make every attempt to accommodate such in a timely manner.

  • All responses will be returned by secure email unless otherwise requested.

1

Instructions for

CS-0435, Rev. 03/14

/ Tennessee Department of Children’s Services
Request for Name and/or Address of Father with Claim of Paternity
REQUEST:(Please Print or Type) / Request Date
Requesting Party
Name and Title:
Agency: / Address
Street:
City: State: Zip Code:
Requesting Party
Telephone:
Fax:
Email Address: / Reason For Request:
Child’s Birth Name
Last:
First:
Middle: / Place of Birth
City:
County:
State:
Sex of Child
Male Female / Child’s Birth Date
Month: Day: Year:
Father’s Name
Last: First: Middle:
Mother’s Name
Last: First: Middle:
Mother’s Maiden Name
Last: First: Middle
RESPONSE: / Response Date
Putative Father’s Name / Address / Date Registered
Date Change of Address / Staff Registrar / Registry Telephone Number

Comments:

Please forward document to: Putative Father Registry---Attn: Registrar

Tennessee Department of Children’s Services

436 Sixth Avenue, North

Nashville, TN 37243-1290

Or Fax: 615-532-6495

Check the “Forms” Webpage for the current version and disregard previous versions. This form may not be altered without prior approval.

Distribution: RDA 2982

CS-0435,Rev. 03/14Page 1