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Center for Health Statistics and informatics

​​Vital Records, Data and Statistics Forms

 

VS 12 (PDF) - Application for Certified Copy of Fetal Death Record

VS 13 E (PDF) - Application for Certified Copy of Certificate of Still Birth

VS 21 (PDF) - Application to Amend a Birth Record-Adjudication of Facts of Parentage | Sample (PDF)

VS 22 (PDF) - Acknowledgement of Paternity/Parentage | Sample (PDF)

VS 23 (PDF) - Amendment of Birth Record to Reflect Court Order Change of Name

VS 24 (PDF) - Affidavit to Amend a Record | Sample (PDF)

VS 24 A (PDF) - Physician/Coroner's Amendment

VS 24 C (PDF)- Affidavit to Amend a Marriage Record | Sample (PDF)

VS 44 (PDF) - Court Report of Adoption | Sample (PDF)

VS 85 (PDF) - Delayed Registration of Birth

VS 105 (PDF) - Court Ordered Delayed Registration of Fetal Death

VS 107 (PDF) - Supplemental Name Report-Birth

VS 108 (PDF) - Court Order Delayed Registration of Birth | Sample (PDF)

VS 109 (PDF) - Court Ordered Delayed Registration of Death | Sample (PDF)

VS 111 (PDF) - Application for Certified Copy of Birth Record

VS 112 (PDF) - Application for Certified Copy of Death Record

VS 113 A (PDF) - Application for Certified Copy of Marriage Record

VS 113 B (PDF) - Application for Certified Copy of Divorce Record

VS 122 (PDF) - Court Ordered Delayed Certificate of Marriage | Sample (PDF)

VS 124 (PDF) - Power of Attorney-California Marriage License

VS 140 (PDF) - Request Vital Records Forms

VS 141 (PDF) - Application for California's Birth and Death Data Files for Research Use

VS 142 (PDF) - Application to Purchase California's Birth and Death Data Files for Local Health Departments

VS 143 (PDF) - Application for California's Anti-Fraud Birth and Death Files

VS 144 (PDF) - Application for California's Birth and Death Data Files for Government Agency Use

VS 145 (PDF) - Application for California's Public Use Birth and Death Files

VS 146 (PDF) - Application for Tabulated California Vital Records Data

VS 147 (PDF) - Application for CDPH Programs Surveillance Use Only

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