California Department of Public Health - Vital Records · California state form
VS 111 Application for Certified Copy of Birth Record
Use VS 111 to request a certified copy of a California birth record from CDPH Vital Records. Choose an authorized or informational copy and provide the required record and applicant details.
- What this form is
- VS 111 is the application for requesting a certified copy of a California birth record from the California Department of Public Health Vital Records. Complete a separate application for each record and select an authorized or informational copy. Authorized copies require an eligible applicant and a notarized sworn statement, except for law enforcement and governmental agencies. The form instructions list the fee and mailing requirements.
- Who needs it
- People requesting a certified copy of a California birth record from CDPH Vital Records, including eligible applicants seeking an authorized copy.
- Why it needs a notary
- An authorized-copy request requires a notarized sworn statement; informational-copy requests do not. The statement can be notarized online with a commissioned online notary.
- How to submit it
- Complete the application, include the fee by check or money order payable to CDPH-Vital Records, and mail it to the address listed in the instructions. Do not send cash.
Questions
Does VS 111 require a notary?
A notarized sworn statement is required for an authorized copy request, with an exception for law enforcement and governmental agencies. No sworn statement is needed for an informational copy.
Who can request an authorized copy of a birth record?
The form lists eligible people and entities, including certain relatives, legal representatives, and government agencies. Applicants who are not eligible for an authorized copy may request an informational copy.
How do I submit VS 111?
Complete the application, include a check or money order for the listed fee payable to CDPH-Vital Records, and mail the materials to the address provided in the form instructions. Do not send cash.