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Petition For Correction Of Birth Certificate

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Probate Court Form No. 200

Petition for Correction of

Birth Certificate

STATE OF VERMONT

PROBATE COURT

DISTRICT OF ___________________

IN RE __________________________

PETITION FOR CORRECTION OF BIRTH CERTIFICATE

TO THE HONORABLE PROBATE COURT FOR THE DISTRICT AFORESAID:

Comes ________________________________________ of ____________________________ in the

County of _________________ and the State of Vermont, and respectfully represents that they were born in

the Town - City of __________________________ in the County of ____________________ and the State of

Vermont, on the _______________ day of ____________________ 20_____.

That the record of their birth appears in the records of the Clerk=s Office of the Town - City of

______________________________ County of __________________________ and the State of Vermont, (a

copy of which is hereto attached) and

That said record contains the following errors and omissions, viz:

________________________________________________________________________________________

_____________________________________________________________________

That said erroneous facts and omission in said record should correctly appear as follows, to wit:

________________________________________________________________________________________

_____________________________________________________________________

WHEREFORE, your petitioner prays that said court, after due notice and hearing, find the facts with

respect to the Record of Birth of your petitioner, issue a decree setting forth the facts found and fill out a

corrected Certificate of Birth in the usual form, and file such certificate with the Clerk of the Town - City of

________________________________, County of _______________________and State of Vermont,

Dated: __________________________

Signed _____________________________

Print Name: _________________________

Address: ____________________________

____________________________________

Telephone: (____) ____________________

Petition For Correction Of Birth Certificate

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