Form Vs-166 - Application For A New Birth Certificate Based On Parentage Form Page 2
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3VS-166 revised 09/2011
THIS FORM (with an attached court order or marriage license, or a filed Acknowledgment of Paternity in
the AOP Registry) MAY BE USED TO:
Add a parent’s information to the birth certificate when the parent’s information is blank on the original birth
certificate. Evidence needed: a certified copy of a court order establishing the paternity of the child, OR a filed
Acknowledgment of Paternity in the AOP Registry if the biological parents are not married to each other, OR the
marriage license of the parents if they are now married to each other,
Change the name and information of the parent listed on a child’s birth certificate to the biological father’s
name and information. This requires a certified copy of a court order OR an Acknowledgment of Paternity signed
by all three parties (the biological mother, the biological father, and the father presently listed on the birth
certificate) and filed in the Acknowledgment of Paternity Registry.
Remove the father or mother’s information. This requires a certified copy of a court order. Please Note: A
Termination of Parental Rights will not remove a biological parent’s information from the birth certificate unless
the court order specifically states the biological parent’s name and information are to be removed.
Substitute the Intended Parents’ names on the birth certificate based on a gestational agreement. This
requires a certified copy of a court order.
SPECIAL INSTRUCTIONS:
If a marriage license or an Acknowledgment of Paternity is being used as evidence, BOTH parents must
sign the application before a notary public.
If a certified copy of a court order is being used as evidence to change the birth certificate, only one parent
is required to sign the application before a notary public.
If you are the father listed and you are having your name removed, a certified copy of a court order is
required to make any change to the child’s name. You are no longer a qualified applicant to receive a copy of the
child’s new birth certificate. Please submit only the $25.00 filing fee. You will receive notification when the
change is made.
A legal guardian or the father listed on the birth certificate may sign the application before a notary public
if a certified copy of a court order establishing or removing paternity is presented as evidence with this
application.
If one or both parents are deceased, a court order is required to file a new birth certificate to add the
biological father’s name and information.
If a birth certificate has previously been changed based on paternity or a court order, a court order is
needed to file a new birth certificate with different information.
NO CHANGES WILL BE MADE TO A BIRTH CERTIFICATE WITHOUT THE FILING FEE
The fee to file a new birth certificate based on paternity, removal of a father or mother’s information,
or a gestational agreement is $25.00. The additional fee for a certified copy of the new birth record
is $22.00. If you have any questions, please call (888) 963-7111.
VS-166 revised 08/2015
Page 2 of 3
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