Cheat Sheet For Birth Amendments - California Department Of Public Health printable pdf download

California Department of Public Health

Vital Records

Cheat Sheet for Birth Amendments

Type of

Form

What the amendment

What to submit…

What happens to the

Amendment

Number

is used for…

original birth certificate…

Acknowledgement of

VS 22

Use this form to:

If the child was born January 1, 1995, or later:

The original birth certificate will be sealed

 add the father/parent’s name to the child’s birth

 Completed VS 22

Paternity/Parentage

and replaced with a new birth certificate.

 If married/State Registered Domestic Partnership (SRDP):

certificate if he/she was not included on the



Health & Safety Code (H&SC) 102755

original birth certificate.

Photocopy of marriage license/SRDP declaration

 change the child’s surname to that of the

certificate

father/parent’s last name only.



Notarized sworn statement

 add the father/parent’s last name to the child’s

 If not married:

last name already listed on the birth certificate.



Photocopy of Declaration of Paternity

(CS 909) – POP form. Note: Only biological

Note: This form must be signed by both parents.

parents may sign POP form

 $20 fee (includes one certified copy of the new birth

certificate)

If the child was born before January 1, 1995:

 Completed VS 22

 Notarized sworn statement

 $20 fee (includes one certified copy of the new birth

certificate)

 Completed VS 21

Adjudication of Facts

VS 21

Use this form to change or remove the father/parent

The original birth certificate is sealed and

(or mother/parent) from who was listed on the child’s

 Certified copy of the court order

of Parentage

replaced with a new birth certificate.

 $20 fee (includes one certified copy of the new birth

original birth certificate.

H&SC 102725

certificate)

 Completed VS 24

Affidavit to Amend a

VS 24

Use this form to correct errors or add information to

The original record remains unchanged, and

 Notarized sworn statement (if certified copy of amended

Birth Record

blank items on birth certificates.

the VS 24 becomes page 2 of the birth

certificate – making it a two-page document.

record is issued)

 Appropriate fee (refer to pamphlet for details)

H&SC 102140 and 103255

Use this form to completely change the registrant’s

 Completed VS 23

Court Order Name

VS 23

The original record remains unchanged, and

 Certified copy of the court order

Change

name.

the VS 23 becomes page 2 of the birth

certificate – making it a two-page document.

 $20 fee (includes one certified copy of the amended birth

H&SC 102140 and 103405

certificate)

 Certified copy of the top portion of VS 108

Court Order Delayed

VS 108

Use this form to register a California birth that was

The bottom portion of VS 108 form becomes

 Completed bottom portion of VS 108

Registration of Birth

never registered or a certified copy is not obtainable.

the birth certificate.

 $20 fee (includes one certified copy of the birth certificate)

Also, if the applicant does not have appropriate

evidence to support a delayed birth.

H&SC 103450

 Completed VS 85

Delayed Registration

VS 85

Use this form to register a California birth when the

The VS 85 form becomes the birth

 $20 fee (includes one certified copy of the birth certificate)

of Birth

birth was not registered within the first year.

certificate.

 Notarized sworn statement

 Documentary evidence

H&SC 102530

 POP laws apply (refer to Acknowledgement of

Paternity/Parentage)

 Completed VS 24

Gender Errors

VS 24

Use this process when incorrect gender information

The original birth certificate is sealed and

 Notarized sworn statement

is entered on the birth certificate.

replaced with a new birth certificate.

 $20 fee (includes one certified copy of the new birth

H&SC 103447.5

certificate)

 Completed VS 24

Gender Reassignment

VS 24

Use this process when a person has undergone

The original birth certificate is sealed and

 Certified copy of court order

clinically appropriate treatment for the purpose of

replaced with a new birth certificate.

gender transition.

 $20 fee (includes one certified copy of the new birth

H&SC 103425

certificate)

 Completed VS 107

Used this form to add only the child’s first, middle or

Supplemental Name

VS 107

The original record remains unchanged, and

 Notarized sworn statement

Report - Birth

last name only.

the VS 107 becomes page 2 of the birth

certificate – making it a two-page document.

 $20 fee (includes one certified copy of the amended birth

H&SC 102140 and 103340

certificate)

Rev (05/12)

Cheat Sheet For Birth Amendments - California Department Of Public Health

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