New York State Department of Health - Vital Records (birth) · New York state form
DOH-4092 Affidavit
DOH-4092 contains the mother’s and husband’s affidavits to request adding the husband as a child’s father on a birth certificate and correcting the child’s name.
- What this form is
- DOH-4092 includes separate affidavits for the mother and husband to request adding the husband as the father on a child’s birth certificate and correcting the child’s name. Both parents must agree on the child’s name, and a copy of their marriage license must be enclosed. The affidavits ask for information about the parents, child, birth, and marriage, and require notarized signatures.
- Who needs it
- A child’s mother and her husband can use these affidavits when requesting that his name be added as father and the child’s name be changed.
- Why it needs a notary
- Both affidavits must be signed before a notary public; online notarization is available with a commissioned online notary.
- How to submit it
- Complete the affidavits, enclose a copy of the marriage license, and mail them to the Vital Records Section/Amendment Unit, P.O. Box 2602, Albany, NY 12220-2602.
Questions
What is DOH-4092 used for?
The affidavits request adding the husband’s name as the father on a child’s birth certificate and changing the child’s name. Both parents must agree on the child’s name.
Does DOH-4092 need to be notarized?
Yes. The document says the affidavits must be signed before a notary public. You can also complete the notarization online with a commissioned online notary.
What must be enclosed with the affidavits?
A copy of the parents’ marriage license must be enclosed. The document says a court order is required to change the child’s name if the parents do not agree.