California Department of Public Health - Vital Records · California state form
VS 23 Application to Amend Birth Record After Court Order Name Change
Use VS 23 to request an amendment to a California birth record reflecting a name change granted by a court order or Hawaii’s Office of the Lieutenant Governor.
- What this form is
- The California Department of Public Health’s VS 23 application is for amending a California birth record after a court-ordered name change. It asks for information matching the current birth certificate, details of the court order, the new name, and the applicant’s signature under penalty of perjury. Submit a certified copy of the court order and payment. A separate notarized sworn statement, form VS 20, is required when requesting a copy of the amended record.
- Who needs it
- Applicants requesting a California birth record amendment to reflect a name change granted by a court order or Hawaii’s Office of the Lieutenant Governor.
- Why it needs a notary
- No notary is needed for the VS 23 signature. The form says to include a separate notarized sworn statement, VS 20, when requesting a copy of the amended record.
- How to submit it
- Complete both pages, include a certified copy of the court order and payment by check or money order payable to CDPH – Vital Records, and mail the package to the address printed on the form.
Questions
What is the VS 23 application used for?
VS 23 is used to amend a California birth record to reflect a name change granted by a court or Hawaii’s Office of the Lieutenant Governor.
What documents and payment should I include?
The form checklist requests a completed VS 23, a certified copy of the court order, and payment by check or money order payable to CDPH Vital Records. Include a notarized VS 20 if requesting a copy of the amended record.
Does the VS 23 application signature need to be notarized?
No notary is needed for the VS 23 signature, which is signed under penalty of perjury. The application says to include a separate notarized sworn statement, form VS 20, when requesting a copy of the amended record.