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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 informational pamphlet Court Order Delayedsample (PDF) form.


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 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

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

Amendment Sworn Statements (English) (Spanish)

Court Order Delayed pamphlet

Directory of County Vital Record Offices


Other Amendment Types

General Birth Amendment

Court Order Name Change

Correcting a Sex Field Error

Sex Change/Reassignment

Adoption

Acknowledgement of Paternity/Parentage

Adjudication of Facts of Parentage

Supplemental Name Report

Death/Fetal Death

Marriage


Delayed and Court Order Delayed Vital Event Types

Delayed Registration of Birth

Court Order Delayed Registration of Birth

Court Order Delayed Registration of Marriage

Court Order Delayed Registration of Fetal Death


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