Stanislaus — Petition to Obtain Copy of Original Unsealed/Underacted Birth Cover Sheet Certificate

Source: https://www.stanislaus.courts.ca.gov/system/files/forms-and-filings/petition-obtain-copy-original-birth-certificate.pdf

Superior Court of California, County of Stanislaus

Cover Sheet: Petition to Obtain Copy of Original Unsealed/Underacted Birth Certificate

Effective Date: November 13, 2025 Last Revision Date: November 13, 2025 Purpose: Adoption records are confidential and can only be inspected after obtaining a court order on a showing of good cause for the necessity to inspect the records.

Assistance: If you are unable to complete the forms on your own, you may wish to hire a private attorney. If you need help finding an attorney, please contact the State Bar of California at www.calbar.ca.gov

Required Forms: There are no Judicial Council forms for this process, but the following pleadings may be used: • Petition to Obtain Copy of Original Unsealed/Underacted Birth Certificate • Order on Petition to Obtain Original Birth Certificate Filing Fee: $435

Copies: Make 2 copies of the completed forms. The Court will file and keep the original and will endorse and return the copies to you. Filing: All forms must be typewritten or printed in blue or black ink. (See California Rules of Court, Rules 2.100-2.119) You can mail or submit completed forms in person in the Clerk's Office located at 1100 I Street, Modesto, Ca 95353. Office hours are 8:00 am to 4:00 pm Monday through Friday, excluding Court holidays. Include a self-addressed stamped envelope.

Petition to Obtain Copy of Original Birth Certificate Page 1 of 1

1 Name: 2 Address: 3 4 Telephone: 5 In Pro Per 6 SUPERIOR COURT OF CALIFORNIA 7 IN AND FOR THE COUNTY OF STANISLAUS 8 9 10 Case No. (if known)_______________11 In the Matter of the Adoption Petition of 12 ________________________________ Petition to Obtain Copy of Original Unsealed/13 (specify case name) Underacted Birth Certificate 14 15 16 I, __________________(name), am the ____________________(relationship) in 17 this matter. 18 On _______________(date), a decree of adoption was entered in this matter,19 20 decreeing ________________________(name of adopted person) to be the adopted child 21 of ______________________________(name of adoptive parents). 22 23 24 25 26 27 28

Petition to Obtain Copy of Original Birth Certificate Page 1 of 3

1 Specify all facts establishing necessity for copy of birth certificate using more than one paragraph. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Wherefore, _________________________ (name) prays for an order directing the 23 clerk of the court to allow that the California Department of Public Health, Vital 24 Records shall furnish Petitioner, with a copy of the original record. (Upon25 26 payment of any fees required by law). SIGN 27 Date: ____________________________________ 28 (Signature of Petitioner)

Petition to Obtain Copy of Birth Certificate Page 2 of 3

1 2 VERIFICATION 3 4 5 I, ______________________(name), am the petitioner in this proceeding. I have 6 read the foregoing petition and know the contents thereof. The same is true of my own 7 knowledge, except as to matters therein alleged on information and belief, and as to those 8 9 matters, I believe it to be true. 10 11 I declare under penalty of perjury under the laws of the state of California that the 12 foregoing is true and correct.13 14 15 SIGN Date: ___________________________________ 16 (Signature of Petitioner) 17 18 19 20 21 22 23 24 25 26 27 28

PRINT CLEAR FORM

Petition to Obtain Copy of Birth Certificate Page 3 of 3

Name, Address of Petitioner or Attorney Telephone No.

PETITIONER

SUPERIOR COURT OF CALIFORNIA, COUNTY OF STAYTSLAUS

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DATED: ___________________ JUDGE OF THE SUPERIOR COURT

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State of California – Health and Human Services Agency California Department of Public Health How to Obtain a Certified Copy of a Birth Record

AVAILABILITY OF RECORDS

Birth records are available 21 days after the date of event. You may request a copy from either the county of birth or from the California Department of Public Health – Vital Records (CDPH-VR). CDPH- VR issues vital records for all of California where as counties can only issue records for events that occurred in that county.

If CDPH-VR cannot locate the record based on the information you provide, the law authorizes CDPH-VR to retain the fee for the search, and CDPH-VR will issue a Certificate of No Public Record (CNPR).

IF THE RECORD NEEDS AMENDMENT

Amendments to original birth records are frequently submitted to CDPH-VR to correct errors or add information to original documents. Copies of amended certificates may be requested at the same time the amendment is submitted. The applicant receives a certified copy once the amendment is completed.

• If you request a certified copy before the amendment has been completed, you may receive either: a copy of the un-amended record, or a CNPR if CDPH-VR is not able to locate the record. • If you know that the record is being amended, and it is in the amended record that you want, please wait until after the amendment has been completed before requesting a certified copy.

CERTIFIED COPIES AND SWORN STATEMENTS

There are two types of certified copies available upon request: 1) Certified Copy (authorized persons only)

A certified copy can be used to establish the identity of the person named on the certificate.

If you are requesting a certified copy, you MUST provide a notarized sworn statement (see page 5 of application) declaring under penalty of perjury that you are authorized by law to receive the certified copy (see application for list of authorized individuals).

If you are requesting a certified copy and a notarized sworn statement is not included, CDPH-VR will not accept your request for processing.

Note: Only one sworn statement is required for multiple records that are requested at the same time – however, the sworn statement must include the name of each person whose record is being requested and your relationship to that person.

VS 111 (2/24) BIRTH

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

2. Certified Informational Copy (any interested person)

If you are requesting a certified informational copy, you DO NOT need to provide a sworn statement.

A certified informational copy has a legend printed on the face of the document that states, “INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY.” Persons who are not eligible to receive a certified copy can receive a certified informational copy.

Both types of documents are certified copies of the original document on file with CDPH-VR. Depending on the exact year of event, some certified informational copies will have signatures and Social Security numbers redacted (concealed).

WHAT TO SUBMIT FOR A CERTIFIED COPY OF A BIRTH CERTIFICATE

□ Completed “Application for Certified Copy of Birth Record” (VS 111). □ Notarized sworn statement (if applicable). □ $29 fee per copy requested (check or money order in US dollars, made payable to CDPH-Vital Records) NO CASH.

APPLICANT NOTIFICATION

Once your request has been received and evaluated:

• If your request is not accepted (e.g., due to insufficient fees, insufficient information, etc.), the request will be returned with a letter explaining what needs to be corrected; or, • If your request is accepted, CDPH-VR will process the application and mail out a copy of the certificate(s) you requested.

PROCESSING TIMES

To check current processing times for certified copies of birth certificates, visit the CDPH-VR Web site (https://www.cdph.ca.gov/Programs/CHSI/Pages/Vital-Records-Processing-Times.aspx).

If you need your copy sooner, please refer to the enclosed list of county recorder’s offices to contact the county where the event occurred.

Mail all applications and written inquiries to the address below. If you have any questions, please contact the CDPH-VR Customer Service Unit, Monday through Friday, 8AM – 4PM.

California Department of Public Health | Vital Records – MS 5103 P.O. Box 997410 | Sacramento CA, 95899-7410 (916) 445-2684 | CHSIVitalRecords@cdph.ca.gov CA Relay: 711/1-800-735-2929

VS 111 (2/24) BIRTH

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

APPLICATION FOR CERTIFIED COPY OF BIRTH RECORD
$29.00 PER COPY
PLEASE READ THE INSTRUCTIONS ON PAGE 2 BEFORE COMPLETING THE APPLICATION.
CERTIFICATE TYPE: I am requesting an AUTHORIZED COPY (notarized sworn statement required)
I am requesting an INFORMATIONAL COPY

Part 1 - Relationship to Person on Certificate (Registrant): Check appropriate box. The registrant or a parent, legal guardian, child, grandparent, grandchild, sibling, spouse, or domestic partner of the registrant. (Legal guardian must provide documentation.) 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. Part 2 - Birth Record Information: Complete the information below as shown on the birth record. Requesting sealed record (if checked, see #3 on instructions page) FIRST Name MIDDLE Name LAST Name

City of Birth (must be California) County of Birth Date of Birth - MM/DD/YYYY (or approximate date)

Parent FIRST Name Parent LAST Name at Birth Parent FIRST Name Parent LAST Name at Birth

Part 3 - Applicant Information: Please PRINT all information legibly. Applicant Name Mailing Address: Number, Street, and Unit # (if applicable)

Zip Code City State/Province Country

Telephone (include area code) Email Address Reason for Request

Agency Use (if applicable) Agency Name Case/ID Number Contract Number

Application Checklist: Check/Money Order Enclosed Notarized Sworn Statemen t Number of (No Cash) Enclosed (if applicable) Copies You may view current processing times on the CDPH-VR website (www.cdph.ca.gov). BIRTH VS 111 (2/24) Page 3 of 5

St ate of California – Health and Human Services Agency California Department of Public Health

INSTRUCTIONS
1. Complete a separate application for each birth record requested.
2. In Part 1, check the appropriate box according to the relationship to the person on the certificate.
ONLY authorized individuals (Health and Safety Code Section 103526) listed in Part 1 may obtain
an authorized copy. All others may receive a certified informational copy that will be marked,
“Informational, Not a Valid Document to Establish Identity.”
3. If adopted and requesting current record, enter the adopted name in Part 2. To request the
original birth certificate, provide a court order releasing the original sealed record and check the
“Requesting sealed record” box.
4. Complete Part 2 and Part 3. In Part 2, provide as much information as possible to help identify
the record.
5. Indicate the number of copies and submit $29.00 for each copy in the form of a check or money
order, made payable to “CDPH-Vital Records” in US dollars. DO NOT SEND CASH.
6. SWORN STATEMENT:
• 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 attached sworn statement
by signing and identifying their relationship to person listed on certificate.
• Sworn statements must be notarized for authorized copy requests. Law enforcement and
governmental agencies 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.
7. Mail completed applications with the fee(s) to the address below.

California Department of Public Health | Vital Records – MS 5103
P.O. Box 997410 | Sacramento, CA 95899-7410
(916) 445-2684 | CHSIVitalRecords@cdph.ca.gov

VS 111 (2/24) BIRTH

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):

Registrant 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. (SIGNATURE OF NOTARY PUBLIC) (SEAL)

VS 20 (7/24) BIRTH