Supplemental Name Report - Birth
A Supplemental Name Report – Birth VS 107 (PDF) form is utilized to:
- Add a first, middle, or last name to blank fields on a birth certificate
For further information please see the informational pamphlet for Supplemental Name Report - Birth (PDF) and checklist.
Supplemental Name Report – Birth is entering a name of the child in the blank spaces on the original birth certificate. No supporting documents are necessary.
A notarized Sworn Statement is required if a certified authorized copy of the amended certificate is requested. For explanation of who may receive a certified authorized copy view this link.
- Within the first year from date of birth: There is no fee to amend a certificate. However, to receive a certified copy of the amended certificate there is a fee of twenty-five dollars ($25) per certified copy
- Any time after the first year of birth: There is a twenty-three dollar ($23) processing fee, which includes one certified copy of the amended certificate. Each additional certified copy is twenty-five dollars ($25)
CDPH-VR processing times may occasionally increase as do the volume of requests.
Currently Supplemental Name Report - Birth are processed within six (6) to eight (8) weeks from the date CDPH-VR receives the request.
- Complete all documents in black ink
- No erasures, alterations or whiteouts are allowed on the VS 107 form
- This will create a multi-page certificate with the amendment attached
Informational Pamphlet Supplemental Name Report - Birth (PDF) and checklist
Supplemental Name Report – Birth VS 107 (PDF) form
Amendment Sworn Statements (English) (Spanish)
Other Amendment Types
General Birth Amendment
Court Order Name Change
Correcting a Sex Field Error
Acknowledgement of Paternity/Parentage
Adjudication of Paternity