Joesph Matthew Jazz
Feb 19, 2007 7lbs 3oz 20in

Arkansas - Putative Father Registry

Statutes: Arkansas Code Ann. sec. 9-9-224

Obtain form from, and return completed form to:

Vital Records

Amendment Section

Slot 44

4815 W. Markham St.

Little Rock, AR 72205-3867

Tel: 501-661-2174

Fax: 501-661-2869.

Original Notarization required. So mail back, do not fax back.



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