Pennsylvania Department of Health - Vital Records · Pennsylvania state form
HD002289 Request to Modify a Child’s Birth Record
Use form HD002289 to request a modification to a child’s birth record when the child is at least 1 year old but younger than 7.
- What this form is
- The Pennsylvania Department of Health form HD002289 is for requesting a modification to a child’s birth record for a child at least 1 year old but younger than 7. It collects contact and identification information, details about the requested changes, and required signatures. Depending on the change, documentary evidence may be required. Each parent listed on the record must sign unless an exception applies, and the signatures must be notarized.
- Who needs it
- A parent or other eligible person requesting a modification to a child’s birth record for a child aged 1 year to less than 7 years.
- Why it needs a notary
- The required signatures must be notarized. You can have them notarized online with a commissioned online notary.
- How to submit it
- Complete the form, include the required identification and any applicable supporting documents, 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 HD002289?
Use this form to request a modification to a child’s birth record when the child is at least 1 year old but less than 7 years old.
Does form HD002289 need to be notarized?
Yes. The form says the required signatures must be signed in front of a notary. You can do this online with a commissioned online notary.
Where do I mail the completed form?
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.