5-C:27 Rescission of Paternity Form. –
I. A parent or legal guardian who is a signatory to the affidavit of paternity shall provide information to complete a rescission of paternity form as follows:
(a) Information about the child, including the child's first, middle, and last names as they appear on the birth record, the child's date of birth, the city or town of birth, the child's social security number, if known, and the child's sex.
(b) Information about the child's father and mother, and the mother's husband if a 3-party affidavit of paternity was completed, including the father's full name, the father's date of birth, the father's mailing address, the mother's full name, the mother's mailing address, whether a completed 3-party affidavit of paternity was submitted and, if a 3-party affidavit was filed, the husband's full name and mailing address.
(c) The rescinder's signature and date.
II. The form shall be attested to by a notary public or justice of the peace. The city or town clerk shall sign and date the form.