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VITAL RECORDS

 

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

To request an informational pamphlet, please provide the recipient’s name, mailing address, and the name of the pamphlet, "Supplemental Name Report - Birth," to the Amendment Section at AMENDVR@cdph.ca.gov or call (916) 445-2684.


Supporting Documents

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.


Sworn Statement

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.


Amendment Fees

  • 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)


Processing Times

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.


Helpful Tips

  • 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


Helpful Links

To request an informational pamphlet, please provide the recipient’s name, mailing address, and the name of the pamphlet, "Supplemental Name Report - Birth," to the Amendment Section at AMENDVR@cdph.ca.gov or call (916) 445-2684.

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

Sex Change/Reassignment

Adoption

Acknowledgement of Paternity/Parentage

Adjudication of Paternity

Death/Fetal Death

Marriage

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