VITAL RECORDS

Court Order Delayed Certificate of Death

A Court Order Delayed Registration of Death VS 109 (PDF) form is utilized to register a death certificate when:

A death record was never registered and is not on file with the State Registrar

For additional information, please see the sample (PDF) form, or the informational pamphlet:

Court Order Delayed (PDF)
(Español) Certificados Retrasados por Orden Judicial (PDF)

Supporting Documents

Supporting documents are used to support the information being amended. Required documents include the following:

Certified Order Establishing Fact of Death (top of VS 109 form)
Court Order Delayed Registration of Death (bottom of VS 109 form)

A certified court order is required when submitting a Court Order Delayed Registration of Death.

Sworn Statement

A notarized Sworn Statement, completed by an authorized person, is required to receive a certified authorized copy of the amended certificate. Please visit the Authorized Copy vs. Informational Copy webpage for a list of authorized persons.

Certified Court Order

A “certified” copy of the court order must be a copy of the order that was originally prepared by the court and signed by the judge. It cannot be an original printout. The photocopy you receive from the court must have all of the following:

An original court seal
A signature (or signature stamp) of the judge
An original signature (or signature stamp) of the court clerk

Amendment Fees

Court Order Delayed Registration of Death requires a twenty-three dollar ($23) registration fee, which includes a certified copy of the death certificate
Additional copies are twenty-one dollars ($21) each

Processing Times

CDPH-VR processing times may occasionally increase as do the volume of requests.

Currently Court Order Delayed Registration of Deaths are processed within ten (10) to twelve (12) weeks from the date CDPH-VR receives the request.

Helpful Tips

Complete all documents in black ink
No erasures, alterations or whiteouts are allowed on the form once it has been certified
This form will assist in creating the new birth certificate