New York State Department of Health - Vital Records (birth) · New York state form
DOH-5722 Affidavit to Correct a Parent’s Name or Gender
Use this affidavit to support a request to correct a parent’s name or gender designation on the birth certificate of a person who is 17 years of age or older.
- What this form is
- DOH-5722 is an affidavit for a parent seeking to correct their name or gender designation on the birth certificate of a person who is 17 years of age or older. The form includes statements about the correction request, signatures and dates for the parents, and a section explaining why the other parent may be unavailable. A notary completes the jurat section.
- Who needs it
- A parent requesting a name or gender correction on a child’s birth certificate when the person whose certificate is being corrected is 17 or older.
- Why it needs a notary
- The affidavit must be notarized. You can complete this notarization 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-5722 used for?
It is an affidavit supporting a request to correct a parent’s name or gender designation on the birth certificate of a person who is 17 years of age or older.
Does DOH-5722 need to be notarized?
Yes. The form includes a section for a notary public to complete after the affidavit is sworn or affirmed. You can notarize it online with a commissioned online notary.
What if the other parent is unavailable?
The form provides options to state that the other parent is deceased, could not be located after a good-faith effort, or that the signer is the child’s sole legal parent or guardian.