Court Order Delayed Certificate of Death

A Court Order Delayed Registration of Death VS 109 (PDF) form is utilized when:

• A death record is not on file with the State Registrar
• Registering a California death that was not previously registered
  

For further information please see the informational pamphlet Court Order Delayed Registration of Death (PDF) and the sample (PDF) form.

Supporting Documents

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

• 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 a required when submitting a Court Order Delayed Registration of Death.

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 six (6) to eight (8) 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

Helpful Links

Informational Pamphlet Court Order Delayed Registration of Death (PDF)

Court Order Delayed Registration of Death VS 109 (PDF) form and sample (PDF) form

Other Types of Amendment Forms

Birth pamphlet/form/checklist

Court Order Name Change pamphlet/form/checklist

New Birth Certificate After Sex Change Reassignment pamphlet/form/checklist

Correcting a Sex Field Error pamphlet/form/checklist

Marriage Certificates pamphlet/form/sample/checklist

Adoption Process pamphlet/form/sample/checklist

Adjudication of Facts of Parentage pamphlet/form/sample/checklist

Acknowledgement of Paternity pamphlet/form/sample/checklist

Death and Fetal Death pamphlet/form/sample/checklist

Delayed Registration of Birth pamphlet/form/checklist

Court Order Delayed Certificate of Marriage pamphlet/form/sample

Court Order Delayed Certificate of Birth pamphlet/form/sample

Court Order Delayed Certificate of Fetal Death pamphlet/form

Supplemental Name Report – Birth pamphlet/form/checklist