www.cdph.ca.gov/CDPH Document Library/ControlledForms/VS111.pdf
State of California, that I am an authorized person, as defined in California Health and Safety Code Section 103526 (c), and am eligible to receive a certified copy of the birth, death, or marriage certificate of the following
application for certified copy of birth record Effective July 1, 2003, California Health and Safety Code Section 103526 changed the way certified copies of birth certificates are issued. Certified Copies to establish the identity of a registrant can be issued only to authorized individuals, as indicated below.
The California Department of Public Health – Vital Records (CDPH-VR) maintains birth, death, fetal death/still birth, marriage, and divorce records for California. Services provided by CDPH-VR include issuing certified copies of California vital records and registering and amending vital records as authorized by law.
State of California. Saving your California location allows us to provide you with more relevant information.
Vital Records, Data and Statistics Forms. For more information on amending vital records, please go to Correcting or Amending Vital Records and Adoptions or Changes in Paternity. VS 12 (PDF) - Application for Certified Copy of Fetal Death Record. VS 13 E (PDF) - Application for Certified Copy of Certificate of Still Birth.
Because a confidential birth certificate contains very personal information, it is not commonly used (or needed) for identification, travel, school, or sports-related purposes. If requesting a birth certificate that contains the confidential information, please write "Confidential Copy" on the application form.
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Birth Certificate # (if you know it): Name of next person whose birth record you want: ... or print neatly. You may use the information from a certificate to complete ... DHCS 0004,Deficit Reduction Act,DRA,Request for California birth record,Medi-Cal,
Application for a Social Security Card Applying for a Social Security Card is free! USE THIS APPLICATION TO: ... For example, you may provide a birth certificate to show your correct date of birth. A document supporting a name change must be recent and identify you by both your old and new names. If the name change
APPLICATION FOR A . BIRTH CERTIFICATE, OR LETTER OF NO RECORD . $28.00 – PER COPY. FEES NON-REFUNDABLE. FOR OFFICIAL USE ONLY. Per California State Law, Health and Safety Code, Section 103526(c), permits only authorized persons as defined below to receive certified copies of Birth Records.