Pennsylvania Department of Health - Vital Records · Pennsylvania state form
HD002290 Request to Modify a Preadolescent Child’s Birth Record
Use this form to request changes to a child’s Pennsylvania birth record when the child is at least 7 years old and younger than 14.
- What this form is
- A parent or other eligible person can use this form to request modifications to a preadolescent child’s birth record. It cannot be used for changes related to adoption or parentage. The form requests contact details, identification, information about the record and requested changes, and applicable supporting documents. Each required signer must sign Part 6 in front of a notary. An updated birth certificate will be issued if requested.
- Who needs it
- A parent or eligible person seeking to modify a birth record for a child who is at least 7 but younger than 14 may use this form.
- Why it needs a notary
- The required signatures must be notarized. Sign Part 6 in front of a notary; this can be done online with a commissioned online notary.
- How to submit it
- Mail the completed form and applicable 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.
Questions
Who can use this birth record modification form?
The form is for requesting modifications to the birth record of a child who is at least 7 years old and younger than 14. It cannot be used for adoption-related changes or changes to parentage.
Does this form need to be notarized?
Yes. The form says required signers must sign Part 6 in front of a notary. This can be done online with a commissioned online notary.
What documents should I include with the request?
Include identification and any documentary evidence required for the requested change. The form lists examples, including certified court orders and birth certificates, and gives mailing instructions.