Pennsylvania Department of Health - Vital Records · Pennsylvania state form
HD002292 Request to Modify an Adult’s Birth Record
Use this form to request changes to an adult’s birth record, including updates to names, birth details, gender designation, or parent information.
- What this form is
- This form requests a modification to the birth record of an individual age 18 or older. It collects contact and identification information, details about the record and requested changes, and the supporting evidence for the amendment. The form also includes the certificate fee section and a notarized statement. It cannot be used for changes resulting from adoption or changes to parentage.
- Who needs it
- An adult seeking to modify their birth record, or an eligible representative submitting a request on the adult’s behalf.
- Why it needs a notary
- The form says to sign Part 6 in front of a notary. 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.
Questions
Who can use the adult birth record modification form?
The form is for modifying the birth record of an individual who is 18 or older. It cannot be used for changes due to adoption or changes to parentage.
Does this form need to be notarized?
Yes. The form instructs the signer to sign Part 6 in front of a notary. This can be done 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.