Fresno — California Department of Health Post-Order Instructions (What to do after receiving your Court order)

Source: https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/Court_Order_Delayed_Pamphlet_ADA.pdf

Court Order Delayed Certificates Center for Health Statistics and Informatics – California Vital Records Effective January 2022 Introduction The court order delayed process is used to register certificates for events that are not registered, or when certified copies of certificates are not available. A statewide search for a certificate is recommended to confirm registration and/or availability of California certificates. • Please visit the CDPH-VR website at www.cdph.ca.gov to request a statewide search.

• Please see page 13 for a list of frequently asked questions and answers. • A court order may not be required. Please contact the Local Registrar in the county where the child was born to register a birth certificate within the first year of the child's birth and review the Delayed Registration of Birth Pamphlet if requesting to register a birth certificate one year or more from the date of birth. • If amending a birth, death, fetal death, or marriage certificate that is already registered, please visit the CDPH-VR website at www.cdph.ca.gov.

What to Submit and Mailing Address

To register a court order delayed certificate, please submit the following: • Properly Completed Application Form (See Form Guidelines beginning on page 3.) • Certified Copy of the Order (See requirements on top section of page 11.) • Name and Mailing Address of Applicant (See requirements in the middle of page 11.) • Appropriate Fee(s) (See requirements on bottom section of page 11.) • Notarized Sworn Statement (Only if requesting authorized copy. See page 12.)

Mail your packet to the address below: California Department of Public Health Vital Records – Amendments – M.S. 5105 P.O. Box 997410 Sacramento, CA 95899-7410

• Registered court order delayed certificates are returned via standard mail and do not
contain a tracking number. 1
• You may provide a prepaid self-addressed envelope with your request for CDPH-VR
to use and mail the registered certificate back to you. (Not Required)

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Registering Court Order Delayed Certificates

Court Order Delayed Certificate Checklist

To assist in the registration of your request, please submit the following:

Properly Completed Order Establishing Facts of Event Form Order Establishing Facts of Event contains the court case number. Name of the petitioner and the name of the person whose event is being established are identified in the Order. Date the order was filed and the hearing date are located on the Order. Facts of the event, including the date, place, and reason why the event is being registered via court order are entered on the Order. Summary of the petition is located on the bottom of the Order. Judge’s signature is located on the bottom of the Order.

Completed Court Order Delayed Registration of Event Form The Court Order Delayed Registration of Event Form is completed with as much available information.

Certified Copy of Order Establishing the Facts of the Event I have enclosed a certified copy of the Order Establishing the Facts of the Event. Note: The Order contains an original court seal, not a photocopy.

Payment for Registration There is a twenty-six dollar ($26) registration fee, which includes one (1) certified copy of the court order delayed certificate. I have enclosed a check/money order (payable to CDPH Vital Records) for twenty- six dollars ($26) for the registration of the certificate.

Payment for Additional Copies of Certificate Birth - I have enclosed a check or money order for thirty-one dollars ($31) per additional copy requested. Death - I have enclosed a check or money order for twenty-six dollars ($26) per additional copy requested. Fetal Death - I have enclosed a check or money order for twenty-three dollars ($23) per additional copy requested. Marriage - I have enclosed a check or money order for nineteen dollars ($19) per additional copy requested.

Notarized Sworn Statement I have requested copies of the court order delayed certificate and would like the copies to be certified authorized copies. I have enclosed a notarized sworn statement.

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Registering Court Order Delayed Certificates

Form Guidelines Please review the applicable court order delayed registration form guidelines: • For birth registrations, review page 3 (below) and page 4 • For death registrations, review pages 5 and 6 • For fetal death registrations, review pages 7 and 8 • For marriage registrations, review pages 9 and 10

Birth – Form Guidelines To prevent processing delays, please adhere to the following guidelines on how to complete the VS 108 - Order Establishing Fact of Birth and Court Order Delayed Registration of Birth form.

Page 1 – Order Establishing Fact of Birth Court Information

All court information must be entered in this section.

Note: The court assigns some information, including the department and court order number.

Petition Information

Petition information must include the following: • Name of the petitioner • Name of the person whose birth is being established • Date the order was filed • Hearing date

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Registering Court Order Delayed Certificates

Birth – Form Guidelines (Continued) Birth Information

Enter birth information in this section, including: • The name of the person whose birth is being established • A brief reason why the birth is being registered through the court • The date of birth and sex marker (gender) for the person • The parent(s) name(s)

Court Order Information

This is a summary of the petition usually entered once the court grants the petition. Note: You may be required to fill this out by the court.

Page 2 - Court Order Delayed Registration of Birth

This form is used to create the court ordered delayed certificate of birth. Enter as much information as known. If unknown, please enter UNK. Note: Only the following two (2) sections are required: • Facts of Birth • Parent(s) section End of Birth – Form Guidelines section.

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Registering Court Order Delayed Certificates

Death – Form Guidelines To prevent processing delays, please adhere to the following guidelines on how to complete the VS 109 - Order Establishing Fact of Death and Court Order Delayed Registration of Death form.

Page 1 – Order Establishing Fact of Death Court Information

All court information must be entered in this section.

Note: The court assigns some information, including the department and court order number.

Petition Information

Petition information must include the following: • Name of the petitioner • Name of the decedent (person whose death is being established) • Date the order was filed • Hearing date

Death Information

Enter death information in this section, including:
• The name of the decedent (person whose death is being established)
• A brief reason why the death is being registered through the court
• The date and place of death

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Registering Court Order Delayed Certificates

Death – Form Guidelines (Continued) Court Order Information

This is a summary of the petition, usually entered once court grants the petition. Note: You may be required to fill this out by the court.

Page 2 - Court Order Delayed Registration of Death

This form is used to create the court order delayed certificate of death.
Enter as much information as known. If unknown, please enter UNK.
Note: Only the following five (5) sections are required:
• Decedent personal data
• Usual residence
• Place of death
• Cause of death
• Injury information End of Death – Form Guidelines section.

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Registering Court Order Delayed Certificates

Fetal Death – Form Guidelines To prevent processing delays, please adhere to the following guidelines on how to complete the VS 105 - Order Establishing Fact of Fetal Death and Court Order Delayed Registration of Fetal Death form. Page 1 – Order Establishing Fact of Fetal Death Court Information

All court information must be entered in this section.

Note: The court assigns some information, including the department and court order number.

Petition Information

Petition information must include the following: • Name of the petitioner • Name of the decedent (person whose fetal death is being established) • Date the order was filed • Hearing date

Fetal Death Information

Enter fetal death information in this section, including: • The name of the decedent (person whose fetal death is being established) • A brief reason why the fetal death is being registered through the court • The date and place of fetal death

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Registering Court Order Delayed Certificates

Fetal Death – Form Guidelines (Continued) Court Order Information

This is a summary of the petition, usually entered once the court grants the petition. Note: You may be required to fill this out by the court.

Page 2 - Court Order Delayed Registration of Fetal Death

This form is used to create the court order delayed certificate of fetal death. Enter as much information as known. If unknown, please enter UNK. Note: Only the following five (5) sections are required: • This Fetus • Place of Event • Father/Parent • Mother/Parent • Confidential Information for Public Health Use Only End of Fetal Death – Form Guidelines section.

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Registering Court Order Delayed Certificates

Marriage – Form Guidelines To prevent processing delays, please adhere to the following guidelines on how to complete the VS 122 - Order Establishing Fact of Marriage and Court Order Delayed Registration of Marriage form. Page 1 – Order Establishing Fact of Marriage Court Information

All court information must be entered in this section.

Note: The court assigns some information, including the department and court order number.

Petition Information

Petition information must include the following: • Name of the petitioner • Names of persons whose marriage is being established • Date the order was filed • Hearing date

Marriage Information

Enter marriage information in this section, including: • The names of the persons whose marriage is being established • A brief reason why the marriage is being registered through the court • The date and place of marriage

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Registering Court Order Delayed Certificates

Marriage – Form Guidelines (Continued) Court Order Information

This is a summary of the petition, usually entered once the court grants the petition. Note: You may be required to fill this out by the court.

Page 2 - Court Order Delayed Registration of Marriage

This form is used to create the court order delayed certificate of marriage.
Enter as much information as known. If unknown, please enter UNK.
Note: Only the following four (4) sections are required:
• First Person Data
• Second Person Data
• Facts of Marriage
• New Names (if any) End of Marriage – Form Guidelines section.

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Registering Court Order Delayed Certificates

Certified Copy of the Order A certified copy of the order establishing the fact of birth, death, fetal death, or marriage is required, as this certifies the order submitted is a true copy of what the court has on file.

A “certified” copy of the order is a photocopy of the original order dated and signed by the judge, which contains a(n): • Original court seal on the front or back of the certified copy and not on a blank sheet of paper. • Signature or signature stamp of the judge’s signature. • Signature or signature stamp of the court clerk’s signature.

Name and Mailing Address of Applicant Please submit a cover sheet that identifies the name and mailing address of the person who should receive the certified copy of the registered certificate.

Appropriate Fee(s) There is a twenty-six dollar ($26) registration fee, which includes one (1) certified copy of the court order delayed certificate. • Each additional certified copy requires the following fee: o Births, each additional copy is thirty-one dollars ($31) o Deaths, each additional copy is twenty-six dollars ($26) o Fetal Deaths, each additional copy is twenty-three dollars ($23) o Marriages, each additional copy is nineteen dollars ($19) • Checks or Money Orders must be made payable to CDPH Vital Records. • International money orders for out-of-country requests must be payable in U.S. dollars.

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Registering Court Order Delayed Certificates

Notarized Sworn Statement An authorized person must submit a notarized sworn statement to receive a certified authorized copy of the amended certificate. Please see list of authorized persons below:

✓Registrant (Name on Certificate) ✓Child/Sibling of Registrant ✓Grandparent/Grandchild of ✓Spouse/Registered Domestic Partner of Registrant Registrant ✓Authorized by Court Order (Include ✓Attorney Representing Registrant or copy of court order.) Registrant’s Estate ✓Law Enforcement/Govt. Agency ✓Parent/Legal Guardian of Registrant (Legal (Conducting Official Business) guardian must provide documentation.) ✓Power of attorney/Executor of the ✓For births only: Attorney/Licensed Adoption registrant’s Estate (Include a copy of Agency (Under CA Family Code Section 3140 the power of attorney or supporting or 7603) documentation identifying you as ✓For deaths only: Individuals specified in HSC executor.) Section 7100 (a)(1)-(a)(8)

The notarized sworn statement must: • Include a penalty of perjury statement • Identify the applicant’s relationship to the registrant (person whose birth certificate is being registered) • Be signed in the presence of a notary public • Contain the notary’s official seal. (NOTE: A sworn statement notarized by a foreign notary must have an apostille attached. Foreign notarizations obtained at a United States Embassy or Consulate do not require an apostille.)

Please see a sample of a sworn statement below. (The notary completes the Certificate of Acknowledgment section after the applicant’s signature is witnessed.)

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Registering Court Order Delayed Certificates

Frequently Asked Questions

Q: Where can I find application forms? A: Application forms, including the co urt order delayed forms, are located on the CDPH -VR Vital Records, Data and Statistics Forms webpage. (www.cdph.ca.gov/Programs/PSB/Pages/BirthDeathMarriageCertificates.aspx)

Q: Where can I find informational pamphlets? A: Informational pamphlets for all amendment types are located on the CDPH-VR Vital Record Pamphlets webpage. (www.cdph.ca.gov/Programs/PSB/Pages/BirthDeathMarriageCertificates.aspx)

Q: How do I obtain a court order? A: CDPH-VR staff cannot provide legal advice, nor does CDPH-VR have information about the legal process. You may find helpful court process information by visiting the court website. (www.courts.ca.gov/)

Q: Who can petition to establish the court order delayed certificate? A: Any beneficially interested person may petition the superior court in any of the f ollowing: • The county in which the birth, death, or marriage is alleged to have occurred. • The county of residence of the person whose birth or marriage it is sought to establish. • The county in which the person was domiciled at the date of death.

Q: What is the current processing time? A: Current processing times are listed on the CDPH-VR website. (www.cdph.ca.gov/Programs/CHSI/Pages/Vital-Records-Processing-Times.aspx)

Q: Will my supporting documents be returned? A: Supporting documents, including certified copies of court orders, will not be returned. Please keep copies of all documents submitted.

Q: What if I still have questions? A: Please contact the CDPH-VR Customer Service Unit by email at AmendVR@cdph.ca.gov or telephone at (916) 445-2684.

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State of California – Health and Human Services Agency California Department of Public Health

Sworn Statement Instructions

• Only one sworn statement is required for multiple records. • Sworn statements are not required for informational copy requests. • Authorized individuals must complete the top portion of the sworn statement by signing and identifying their relationship to person listed on certificate. • Sworn statements must be notarized for authorized copy requests. Law enforcement, governmental agencies, and funeral establishments (death records only) are exempt from the notary requirement, but must complete the top portion of the sworn statement page. • A sworn statement notarized by a foreign notary must have an apostille attached. Foreign notarizations obtained by an Ambassador, Minister, Consul, Vice Consul or Consular Agent of the United States, or from a Judge of Court of record having a seal in a foreign county do not require an apostille.

Relationship to Registrant

List of Authorized Persons:

• The registrant or a parent, legal guardian, child, grandparent, grandchild, sibling, spouse, or domestic partner of the registrant. • A party entitled to receive the record as a result of court order or an attorney or licensed adoption agency seeking the birth record in order to comply with the requirements of Section 3140 or 7603 of the Family Code. (Please include a copy of the court order.) • A member of a law enforcement agency or a representative of another governmental agency, as provided by law, who is conducting official business. (Companies representing a government agency must provide authorization from the government agency.) • Any person or agency empowered by statute or appointed by a court to act on behalf of the registrant or the registrant’s estate (Include a copy of the power of attorney or documentation identifying you as executor.) • An attorney representing the registrant or the registrant’s estate. • Any agent or employee of a funeral establishment who acts within the course and scope of employment and on behalf of persons specified in HSC § 7100 (a) (1)-(8). • Surviving next of kin (As specified in HSC § 7100).

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State of California – Health and Human Services Agency California Department of Public Health

Sworn Statement
I, , declare under penalty of perjury under the laws of the
(Applicant’s Printed Name)

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 individual(s):

Regis trant Applicant's Relationship to Registrant (Name of person whose certificate (Must be an authorized person)
you are requesting)

(The remaining information must be completed in the presence of a Notary Public.)

Subscribed to this day of , 20 , at , . (Day) (Month) (City) (State) SIGN

(Applicant’s Signature)

Certificate of Acknowledgment

A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of County of On before me, , personally appeared , (Insert name and title of the officer) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct SIGN WITNESS my hand and official seal. (SEAL) (Signature of Notary Public)

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