Pennsylvania Department of Health - Vital Records · Pennsylvania state form
Request to Modify a Child’s Birth Record, HD002289
Spanish-language application to request changes to a child’s Pennsylvania birth record for children ages 1 to under 7. Signatures in Part 6 must be notarized.
- What this form is
- Use this Spanish-language application to request changes to a child’s birth record when the child is age 1 to under 7. The form is not for changes related to adoption or parentage. It requests contact information, identification, payment or fee-waiver details, the record and requested changes, signatures, and supporting documents when applicable. Part 6 must be signed in the presence of a notary.
- Who needs it
- A parent or other eligible person seeking to modify a child’s birth record for a child age 1 to under 7 may use this application.
- Why it needs a notary
- Part 6 must be signed in the presence of a notary. You can complete the notarization online with a commissioned online notary.
- How to submit it
- Mail the completed application and applicable documents to Pa. 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 this application?
Use this application to request changes to a child’s birth record when the child is age 1 to under 7. It cannot be used for changes related to adoption or parentage.
Does this application need to be notarized?
Yes. Part 6 states that signatures must be made in the presence of a notary. You can complete the notarization online with a commissioned online notary.
Where do I mail the application?
Mail it to Pa. Department of Health, Bureau of Health Statistics and Registries, ATTN: Birth Registry, 555 Walnut St., 6th Floor, Harrisburg, PA 17101-1934.