Pennsylvania Department of Health - Vital Records · Pennsylvania state form
HD002109 Request to Modify Parentage (Spanish)
Spanish-language form for requesting a change to parentage on a child’s birth record. It includes contact, identification, record, supporting-document, and signature sections.
- What this form is
- Use this form to request adding or removing a parent on a child’s birth record. The form asks for applicant and child information, identification documents, the requested change, and applicable supporting evidence. Both parents generally must sign, with exceptions described in the form. Certain applicants must sign before a notary. The form states that removing a parent requires a court order or an approved cancellation of an Acknowledgment of Paternity.
- Who needs it
- A parent, the adult named on the record, or an eligible custodian or guardian seeking to modify parentage on a child’s birth record.
- Why it needs a notary
- Notarization is required for certain applicants and situations listed on the form; it can be completed online with a commissioned online notary.
- How to submit it
- Complete the applicable sections, include the required identification and supporting documents, and mail the request to the Pennsylvania Department of Health, Bureau of Health Statistics and Registries, ATTN: Birth Registry, at the address printed on the form.
Questions
What is form HD002109 used for?
This Spanish-language form requests a modification of parentage on a child’s birth record. It can be used to request adding or removing a parent, subject to the form’s documentation requirements.
Does this form need to be notarized?
Notarization is required in certain situations described on the form, including specified custody circumstances. When notarization is required, it can be completed online with a commissioned online notary.
Where do I mail the completed form?
The form directs applicants to mail it to the Pennsylvania Department of Health, Bureau of Health Statistics and Registries, ATTN: Birth Registry, at the address printed on the form.