Supplemental Name Report - Birth
A Supplemental Name Report – Birth VS 107 (PDF) form is utilized to:
- Add the registrant's first, middle, and/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.
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, 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.
- 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
Supplemental Name Report – Birth VS 107 (PDF) form
Amendment Sworn Statements (English) (Spanish)
Directory of County Vital Record Offices
Other Amendment Types
General Birth Amendment
Court Order Name Change
Correcting a Sex Field Error
Acknowledgement of Paternity/Parentage
Adjudication of Facts of Parentage