Pennsylvania Department of Health - Vital Records · Pennsylvania state form
HD002109 Request to Modify Parentage on a Birth Record
Use form HD002109 to request a change to parentage on a child’s birth record. Notarization is required for certain applicants and circumstances.
- What this form is
- Form HD002109 is used to request adding or removing a parent on a child’s birth record. The form collects applicant and child information, identification details, the requested change, and signatures. It identifies supporting documents required for different types of requests. Notarization applies in specified circumstances, including certain sole-custody or surviving-parent situations, and the form explains who must sign.
- Who needs it
- A parent, adult child, or qualifying legal guardian requesting a parentage change on a child’s birth record may use this form.
- Why it needs a notary
- Notarization is required in the circumstances listed in Part 6; when required, signatures can be notarized online with a commissioned online notary.
- How to submit it
- Complete the form, include applicable identification and documentary evidence, and mail it to the Pennsylvania Department of Health, Bureau of Health Statistics and Registries, ATTN: Birth Registry, 555 Walnut St., 6th Floor, Harrisburg, PA 17101-1934.
Questions
Who can use form HD002109?
The form is for requests to modify parentage on a child’s birth record. It includes options for a parent or an adult child to apply, and specifies when a qualifying legal guardian may request a change.
Does this form need to be notarized?
Only certain applicants and situations require notarization, as listed in Part 6. When notarization is required, the signature can be notarized online with a commissioned online notary.
Where do I mail the completed form?
Mail the form and applicable supporting documents to the Pennsylvania Department of Health, Bureau of Health Statistics and Registries, ATTN: Birth Registry, 555 Walnut St., 6th Floor, Harrisburg, PA 17101-1934.