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Center for Health Statistics and informatics

*** Effective June 18, 2022 the Amendment Request Portal (ARP) will be used to create the Court Report of Adoption (VS 44) Form ***

​​Vital Records, Data and​​ Statistics Forms

CDPH 9126 (PDF)​​ - Application for Requesting a Sealed Record

VS 12, 13 E (PDF) - Application for Certified Copy of Fetal Death Record or Still Birth Record

VS 12, 13 E SP (PDF)​ - Application for Certified Copy of Fetal Death Record or Still Birth Record

VS 20 (PDF) - Sworn Statement

VS 20 SP (PDF) - Sworn Statement

VS 21 (PDF, 1.1MB)​ - Application to Amend a Birth Record-Amendment of Parentage

VS 21 SP (PDF, 3.6MB)​​ - Application to Amend a Birth Record-Amendment of Parentage​​

VS 23 (PDF) - Application to Amend a Birth Record After a Court Order Name Change

VS 23 SP (PDF) - Application to Amend a Birth Record After a Court Order Name Change

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

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

VS 24 B (PDF, 1.2MB) ​- Application to Amend a Birth Record

VS 24 B SP (PDF, 1.2MB) - Application to Amend a Birth Record

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

VS 24 C SP (PDF) - Application to Amend a Marriage Record

VS 44 (WEB FORM) - Court Report of Adoption | ARP Instruction Presentation (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 111 SP (PDF) - Application for Certified Copy of Birth Record

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

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

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

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

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

VS 113 B SP (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 146 (PDF) - Application for Tabulated California Vital Records Data

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

VS 148 (PDF) - CDPH Program Request for OSHPD Data ​
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Other​​ Vital Records Forms

CDPH 9051 (PDF) - California Integrated Vital Records System Account Registration Form

CDPH 9052 (PDF) - California Integrated Vital Records System Account Modification Request​

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