The following must be provided to the bureau by/for a person who is to be entered into the registry:

1. A. For a father who is being entered as a result of a court order, a certified copy of a court order from a court of competent jurisdiction ordering the inclusion of the father’s name in the registry and the information called for in Section 12.3 [now Subsection C of 7.2.3.12 NMAC].
2. B. For affirmative requests from persons requesting inclusion in the registry, a signed notarized statement on a form provided by the bureau that he wishes to be entered into the registry and the information specified in Section 12.3 [now Subsection C of 7.2.3.12 NMAC] shall be provided.

3. C.

   (1) The putative father’s full name, complete address and complete telephone number; and

   (2) The putative father’s date of birth and place of birth, including state and county; and

   (3) The date (or expected date) of birth of the child for whom the registrant is affirmatively assuming responsibility, the place (or expected place) of birth of the child and (if born) the child’s full name; and

   (4) The full maiden name of (and any other name which may be used by) the mother of the child, her date and place of birth if known and last known full address of the mother; and

   (5) Other information as required by the state registrar to make retrieval of the information possible and to serve the ends for which the registry was created.

   [9/7/94, 10/31/96; Recompiled 10/31/01]