CDPH - VITAL RECORDS OR LOCAL REGISTRAR 15. DATE ACCEPTED FOR REGISTRATION STATE OF CALIFORNIA DEPARTMENT OF PUBLIC HEALTH - VITAL RECORDS FORM VS 24 REV. AFFIDAVIT TO AMEND A RECORD STATE FILE NUMBER NO ERASURES WHITEOUTS PHOTOCOPIES OR ALTERATIONS BIRTH DEATH LOCAL REGISTRATION NUMBER FETAL DEATH TYPE OR PRINT CLEARLY IN BLACK INK ONLY THIS AMENDMENT BECOMES AN ACTUAL PART OF THE OFFICIAL RECORD PART I INFORMATION TO LOCATE RECORD 1A. NAME FIRST AS IT APPEARS ON ORIGINAL RECORD 2. SEX 1B. MIDDLE 3. DATE OF EVENT MM/DD/CCYY 1C. LAST 4. CITY OF EVENT 6. FULL NAME OF PARENT AS STATED ON ORIGINAL RECORD 5. COUNTY OF EVENT STATEMENT OF CORRECTIONS TO BIRTH DEATH OR FETAL DEATH RECORD 8. ITEM NUMBER TO BE CORRECTED 9. INCORRECT INFORMATION THAT APPEARS ON ORIGINAL RECORD 10. CORRECTED INFORMATION AS IT SHOULD APPEAR LIST ONE ITEM PER LINE REASON FOR CORRECTION We the undersigned hereby certify under penalty of perjury that we have personal knowledge of the above facts and that the informat....
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How to fill out the CA VS 24 online
Filling out the CA VS 24 form, also known as the affidavit to amend a record, is a straightforward process that requires careful attention to detail. This guide will provide you with step-by-step instructions to help you complete the form accurately and efficiently, ensuring your amendments are processed promptly.
Follow the steps to successfully complete the CA VS 24 form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by sectioning Part I, where you will provide information to locate the record. Input the name as it currently appears on the record in the appropriate fields for first, middle, and last name.
- Next, in Part II, fill out the sex, date of event (in MM/DD/CCYY format), and the city and county of the event.
- Continue by providing the full names of both parents as stated on the current record.
- Move on to the statement of corrections section. In Item 8, indicate the item number that requires correction. Remember to list one item per line.
- In Item 9, enter the incorrect information that is currently on the record, and in Item 10, specify the corrected information that you want to appear.
- In Item 11, provide a brief reason for the correction you are making.
- Review the affidavit statement. Ensure that two individuals are available to sign the form, certifying the accuracy of the information provided.
- Leave Items 14 and 15 blank, as these sections are for State or Local Registrar use only.
- Finalize your submission by making sure the application form is duly completed and signed by both parties. You may need to attach the necessary fees as indicated in the guidelines.
- Once you have filled out the form, you can save the changes, download the document, print it, or share it as needed.
Start completing your CA VS 24 form online today to ensure your amendments are processed efficiently.
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