Affidavit To Correct Or Amend A Birth Certificate
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3AFFIDAVIT TO CORRECT OR AMEND A BIRTH CERTIFICATE
Instructions
1. Please type or print using black or blue ink only and separate the first, middle and last names by using commas.
2. Do not make any alterations after the information has been entered on the affidavit. ALTERATIONS SHALL INVALIDATE THIS
AFFIDAVIT and you will be required to complete a new affidavit.
3. If both parents are listed on the birth record and the child’s name is being changed, both parents must sign the affidavit in the
presence of a notary.
4. The following fields must always be completed on the affidavit: child’s name (first, middle and last), mother’s name prior to first
marriage (maiden name—first, middle and last), child’s date of birth.
To add a first and middle name to a birth record (child not named at birth)
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If your child is 3 months of age or less, this affidavit is all you will need to complete.
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If your child is over 3 months and less than 1 year old, complete this affidavit and submit an independent factual document
created within the first six months of the child’s birth.
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Note: If your child is less than 1 year of age—the last name can be changed also.
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If your child is 1 to 6 years of age, complete this affidavit and submit an independent factual document created within the
first six months of the child’s birth that lists the name as you want it to appear on the birth record (examples: baptismal
or medical record). The document must show the child’s complete name, date of birth, and the date the document was
originally created. Note: If the child is 1 year of age or older a certified court order is required to change the last name of
the child.
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To add a name to a birth record for a child 6 years of age and older, a certified, court ordered name change is required.
To change a name listed on the birth record (child named at birth)
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If your child is 3 months of age or less, this affidavit is all you will need to complete.
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If your child is over 3 months and less than 1 year of age, complete this affidavit and submit an independent factual
document created within the first six months of the child’s birth that lists the name as you want it to appear on the birth
record (examples: baptismal or medical record). The document must show the child’s complete name, date of birth, and
the date the document was originally created.
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To change a name one year or more after birth, a certified, court ordered name change is required.
To correct a typographical error or a misspelled or transposed letter or number—(example: Vasquez to Vasques)
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If the child is less than 1 year of age, complete this affidavit.
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If the child is more than 1 year of age, complete this affidavit and submit an independent factual document that lists the
name as you want it to appear on the birth record (examples: baptismal or medical record). The document must show the
child’s complete name, date of birth, and the date the document was originally created.
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To correct parents’ information, complete this affidavit and submit and independent factual document (examples: original,
certified birth certificate or passport). Note: If parent is changing their complete name, then a certified court ordered name
change is required. If the mother/father listed an alias name on the registrant’s birth record, then a court order listing the
alias names and the correct legal name is required to amend the birth record. Court orders submitted must be certified
by the court where the order was finalized.
“Other Changes” Field—this field may be used to specify other requested corrections on the birth record such as mother’s
date of birth and place of birth, etc. Please specify the field name or number you want to amend in the Data field column on the
affidavit.
VS-41 02-13-2015
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