New York State Department of Health - Vital Records (birth) · New York state form
DOH-5721 Affidavit to Correct a Parent’s Name or Gender
DOH-5721 is an affidavit for parents seeking to correct a parent’s name or gender on a child’s birth certificate when the child is 16 or younger.
- What this form is
- Use DOH-5721 to support an application to correct a parent’s name or gender on the birth certificate of a child age 16 or younger. The affidavit asks the parent or parents to attest to their relationship to the child and the accuracy of the statements. It includes spaces for signatures and dates and a section for a notary to complete.
- Who needs it
- A parent seeking a name or gender correction on a child’s birth certificate for a child age 16 or younger may need this affidavit.
- Why it needs a notary
- The affidavit includes a jurat stating it is subscribed and sworn or affirmed before a notary. It can be notarized online with a commissioned online notary.
- How to submit it
- Submit it to the New York agency named on the form.
Questions
What is DOH-5721 used for?
It is an affidavit supporting an application to correct a parent’s name or gender on a child’s birth certificate for a child age 16 or younger.
Who completes this affidavit?
The form provides spaces for the parent seeking the correction and the other parent to print their names, sign, and date. It also includes a section for a notary.
Does DOH-5721 need to be notarized?
Yes. The affidavit states that it is subscribed and sworn or affirmed before a notary. You can complete the notarization online with a commissioned online notary.