Pennsylvania Department of Health - Vital Records · Pennsylvania state form

HD002292 Adult Birth Record Amendment Request (Spanish)

Spanish-language application to request changes to an adult’s Pennsylvania birth record. The applicant must provide identification, supporting documents, and a notarized signature.

What this form is

Use this Spanish-language application to request a change to the birth record of an individual age 18 or older. The form collects contact information, identification details, the requested changes, and supporting documentation. The applicant must sign Part 6 before a notary. The form states that a corrected birth certificate will be issued upon request after the record is updated.

Who needs it

An adult listed on a birth record, or someone applying on that adult’s behalf, who is requesting an eligible record change.

Why it needs a notary

The form requires the applicant to sign Part 6 in a notary’s presence. This signature can be notarized online with a commissioned online notary.

How to submit it

Mail the completed 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.