Skip Navigation LinksSupplemental-Name-Report---Birth

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

For further information please see the informational pamphlet for Supplemental Name Report - Birth (PDF) and checklist.


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

Informational Pamphlet Supplemental Name Report - Birth (PDF) and checklist

Supplemental Name Report – Birth VS 107 (PDF) form

Sworn Statement


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 Death pamphlet/form/sample

Court Order Delayed Certificate of Fetal Death pamphlet/form

Page Last Updated :