Vs 24 C Template Access Vs 24 C Editor Now

Vs 24 C Template

The VS 24 C form, officially termed as the Affidavit to Amend a Record, is a crucial document used for making corrections to birth, death, or fetal death records in the state of California. It details a step-by-step process for requesting amendments, necessitating accurate information typed in black ink without any erasures, whiteouts, photocopies, or alterations, ensuring the integrity of the official record. Individuals seeking corrections must submit this form alongside affidavits and signatures from two persons verifying the authenticity of the corrections, highlighting the form's significance in maintaining the accuracy of vital records. Ready to make necessary corrections? Click the button below to start filling out your form.

Access Vs 24 C Editor Now
Table of Contents

Understanding the intricacies of official documentation can often be a daunting task, especially when it involves making amendments to vital records such as birth, death, or fetal death records. The Vs 24 C form, an Affidavit to Amend a Record, serves a crucial role in this process by providing a structured method for requesting updates or corrections to these sensitive documents. Described as an affidavit, this form requires the utmost accuracy and complete avoidance of erasures, whiteouts, photocopies, or alterations to maintain the integrity of the official record. It specifically demands that all information be typed or printed clearly in black ink, reinforcing the importance of clarity and legibility. Individuals seeking amendments must detail the current record's information, specify the incorrect details, and state the corrected information, ensuring the form comprehensively addresses the correction needs. Additionally, the requirement for affidavits and signatures from two individuals with personal knowledge of the facts underscores the form's emphasis on verification and authenticity. The process also includes a nuanced fee structure that varies depending on the timing of the amendment submission, which highlights the procedural aspects of making such requests. The comprehensive approach taken by the Vs 24 C form includes strict submission guidelines and is designed to maintain the official record's accuracy and reliability while accommodating necessary changes.

Form Preview

AFFIDAVIT TO AMEND A RECORD

_______________________________

NO ERASURES, WHITEOUTS, PHOTOCOPIES,

______________________________

STATE FILE NUMBER

 

OR ALTERATIONS

LOCAL REGISTRATION NUMBER

BIRTH

DEATH 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

INFORMATION AS IT APPEARS ON CURRENT RECORD

 

1A. NAME—FIRST

1B. MIDDLE

 

 

 

1C. LAST

 

 

 

 

 

 

 

 

 

2. SEX

3. DATE OF EVENT—MM/DD/CCYY

4. CITY OF EVENT

 

5. COUNTY OF EVENT

 

 

 

 

 

 

 

 

6. FULL NAME OF PARENT AS STATED ON CURRENT RECORD

 

 

7. FULL NAME OF PARENT AS STATED ON CURRENT RECORD

 

 

 

 

 

 

 

 

PART II STATEMENT OF CORRECTIONS TO BIRTH, DEATH, OR FETAL DEATH RECORD

LIST ONE ITEM PER LINE

8.ITEM

NUMBER TO BE

CORRECTED

9. INCORRECT INFORMATION THAT APPEARS ON CURRENT RECORD

10. CORRECTED INFORMATION AS IT SHOULD APPEAR

REASON FOR CORRECTION

11.

AFFIDAVITS

AND

SIGNATURES

TWO

PERSONS

MUST SIGN

THIS FORM TO

CORRECT A

BIRTH, DEATH,

OR FETAL

DEATH

RECORD

We, the undersigned, hereby certify under penalty of perjury that we have personal knowledge of the above facts and that the information given above is true and correct.

12A. SIGNATURE OF FIRST PERSON12B. PRINTED NAME12C. TITLE/RELATIONSHIP TO PERSON IN PART I

12D. ADDRESS (STREET and NUMBER, CITY, STATE, ZIP)

 

12E. DATE SIGNED—MM/DD/CCYY

 

 

 

13A. SIGNATURE OF SECOND PERSON

13B. PRINTED NAME

13C. TITLE/RELATIONSHIP TO PERSON IN PART I

 

 

13D. ADDRESS (STREET and NUMBER, CITY, STATE, ZIP)

 

13E. DATE SIGNED—MM/DD/CCYY

STATE/LOCAL

REGISTRAR

USE ONLY

14. CDPH - VITAL RECORDS OR LOCAL REGISTRAR

15. DATE ACCEPTED FOR REGISTRATION

STATE OF CALIFORNIA, DEPARTMENT OF PUBLIC HEALTH - VITAL RECORDS

FORM VS 24 (REV. 04/20)

APPLICATION TO AMEND A RECORD

TYPE OR PRINT CLEARLY IN BLACK INK ONLY

NO ERASURES, WHITEOUTS, PHOTOCOPIES, OR ALTERATIONS

If an acceptable application to amend the record is registered within one year of the date of the event, there is no processing fee; however, there is a fee required for a certified copy.

Enclosed is the fee of $___________________________ for a certified copy of the newly amended record.

If an acceptable application to amend the record is registered one year or more after the date of the event, there is a fee for filing the affidavit, which includes one certified copy. There is a fee for each additional certified copy. Please contact your Local Registrar, County Recorder, or the State Registrar for the current fees, or visit our website at www.cdph.ca.gov.

Enclosed is the fee of $___________________________ for filing the affidavit and one certified copy of the newly amended record.

Enclosed is the fee of $___________________________ for an additional certified copy(ies) of the newly amended record.

______________________________________________

______________________________________________________________________

Printed Name of Applicant

 

Mailing Address of Applicant

Telephone Number (

) ________________________

______________________________________________________________________

Email Address: _________________________________

City, State, ZIP Code

 

GENERAL INFORMATION

1.The original certificate cannot be altered.

2.This amendment becomes a part of the original record, so please type or print clearly in black ink only.

3.Please submit original amendment form only. Photocopies of the amendment form will be rejected.

4.Your certified copy will include a copy of the original certificate with a copy of the amendment.

5.The certified copy of the certificate and the attached amendment must remain together for the certified copy to be valid.

READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THE FORM

1.A Notarized Sworn Statement is required when requesting a certified authorized copy of the amended certificate. For more information please visit our website at www.cdph.ca.gov.

2.This form becomes a part of the original record – type or print clearly in black ink only.

3.No erasures, whiteouts, photocopies, or alterations allowed.

4.Complete Part I, Items 1 – 7, with the information as it appears on the current certificate.

5.Enter the certificate item number(s) to be corrected, either from the original or subsequent amendment, in Part II—Item 8. List one item per line.

6.Enter the incorrect information that appears on the current certificate in the line(s) provided below Item 9.

7.In Item 10, enter the correct information as it should appear for each item listed in Item 9.

8.Enter the reason for the correction in Item 11.

9.Read the affidavit statement. Two persons who are certifying to the statement of corrections must sign the form.

10.Do not write in Items 14 or 15. This space is reserved for State or Local Registrar use only.

11.Make check or money order payable to CDPH - Vital Records. When the paperwork is properly completed and signed by two parties, return this form, together with the required fee(s), to:

California Department of Public Health

Vital Records - Amendments - MS 5105

P.O. Box 997410

Sacramento, CA 95899-7410

Form Breakdown

Fact Number Detail Governing Law(s)
1 The VS 24 C form is used to amend California vital records, including birth, death, and fetal death records. California Health and Safety Code
2 Amendments must be clearly typed or printed in black ink to become an actual part of the official record. California Department of Public Health - Vital Records guidelines
3 No erasures, whiteouts, photocopies, or alterations are permitted on the form. California Department of Public Health - Vital Records guidelines
4 If the application to amend is accepted within one year of the event date, no processing fee is charged, barring the fee for a certified copy of the amended record. California Health and Safety Code
5 Applications submitted one year or more after the event date are subject to a filing fee, which includes one certified copy. California Health and Safety Code
6 A certified copy of the amended record must include both the original certificate and the amendment. California Department of Public Health - Vital Records guidelines
7 A Notarized Sworn Statement is required for requesting a certified authorized copy of the amended certificate. California Health and Safety Code
8 Two individuals with personal knowledge must sign the affidavit to correct a record, certifying that the information provided is true and correct. California Health and Safety Code
9 The form restricts corrections to one item per line in Part II for clarity and documentation purposes. California Department of Public Health - Vital Records guidelines
10 Payments for any fees associated with the amendment must be made payable to CDPH - Vital Records and submitted with the form. California Department of Public Health - Vital Records guidelines

Guidelines on Filling in Vs 24 C

Filling out the VS 24 C form is a critical step in amending a vital record in California, whether for a birth, death, or fetal death record. This form allows for corrections to be officially made and becomes part of the original record. It's important to follow each step carefully to ensure the process goes smoothly and your request is processed without unnecessary delays. Here is a straightforward guide to help you complete the form accurately.

  1. Prepare to fill out the form: Gather all necessary documents and information that verify the corrections you intend to make. Remember, the form must be filled out in black ink and no photocopies, white-outs, or alterations can be made to the form.
  2. Part I - Information to locate the record: Enter the current information exactly as it appears on the existing record for the individual's name (first, middle, last), sex, date of the event, city and county of the event, and the full names of the parents as stated on the current record.
  3. Part II - Statement of corrections:
    • List the item number(s) from the original or subsequent amendment that need correction in Item 8.
    • For each item identified in Item 8, enter the incorrect information as it currently appears on the record in Item 9, and then the corrected information as it should appear in Item 10.
    • Explain why the correction is needed in Item 11.
  4. Affidavits and Signatures: Two individuals with personal knowledge of the facts must sign the form, certifying that the information provided is true and correct. They must fill in their signatures, printed names, titles or relationships to the person in Part I, addresses, and dates signed.
  5. Fees: Determine if a fee is applicable based on the timing of the amendment application. Fill in the necessary fee section at the beginning of the form and include the correct fee with your submission if applicable.
  6. Submission: Do not write in Items 14 or 15, as these are for official use only. Double-check the form for accuracy and completeness. Then, make a check or money order payable to CDPH - Vital Records and send the form, along with any required fees and notarized sworn statement if requesting a certified authorized copy, to the address provided on the form.

After submitting the VS 24 C form, the amendment process will take some time. The state department will review your submission, verify the information, and, if approved, issue an amended certificate. The certified copy of the amended certificate will then be sent to the address you provided. This copy, along with the amendment, must remain together at all times to be considered valid. Keep in mind, making official amendments to vital records is a significant process, so ensuring the accuracy and completeness of your submission can help avoid delays and additional fees.

Learn More on Vs 24 C

What is the VS 24 C form used for?

The VS 24 C form, also known as the Affidavit to Amend a Record, is utilized to make corrections to a vital record in the state of California. This includes records pertaining to birth, death, or fetal death. It allows for the official amendment of personal details on these documents when incorrect information has been initially recorded.

Who can submit a VS 24 C form?

Two individuals with personal knowledge of the facts needing correction must submit the VS 24 C form. They certify under penalty of perjury that the information they are providing for the amendment is true and correct. The individuals must indicate their relationship to the person on the record and their contact information.

What are the fees associated with the VS 24 C form?

The fees for filing a VS 24 C form vary depending on the timing of the amendment and the need for certified copies:

  • If an acceptable application to amend the record is registered within one year of the event date, no processing fee is charged. However, there is a fee for any certified copies requested.
  • If the application is registered one year or more after the event, a filing fee is required. This includes a fee for the affidavit and one certified copy. Fees for additional copies apply.
Individuals are advised to contact their Local Registrar, County Recorder, or the State Registrar for current fees or visit the California Department of Public Health website.

What information is needed to fill out a VS 24 C form?

To correctly complete the VS 24 C form, the following information is necessary:

  1. Details as they currently appear on the record (i.e., name, sex, date and place of event, full names of parents).
  2. The specific item number on the certificate that needs correction.
  3. The incorrect information currently appearing on the certificate.
  4. The corrected information as it should appear.
  5. The reason for the correction.
  6. Signatures, printed names, and titles/relationships of the two individuals requesting the amendment.
It's vital to type or print clearly in black ink, as this form becomes a part of the original record.

Are there any restrictions on amending a vital record using the VS 24 C form?

Yes, there are specific restrictions:

  • Original certificates cannot be altered or physically changed. The amendment is an attachment that becomes part of the official record.
  • Erasures, whiteouts, photocopies, and alterations of the form are strictly prohibited.
  • The amendment form must be the original version. Photocopies of the form will not be accepted.

How does one obtain a certified copy of the amended record?

Upon processing the VS 24 C form, a certified copy of the amended record can be requested. This includes the original certificate along with the amendment. The certified copy and the amendment must remain together to be valid. An appropriate fee, as indicated by the California Department of Public Health or local agencies, is required for the certified copy.

Can amendments be made to all details on a birth, death, or fetal death record?

Not all details on a vital record can be amended. Generally, corrections can be made to most informational errors. However, there are certain restrictions, especially concerning legal changes (e.g., name changes after adoption) that may require a court order or additional documentation. For specifics on what can be amended, it is advised to consult with the California Department of Public Health or a legal professional.

What happens if an amendment request is not accepted?

If an amendment request via the VS 24 C form is not accepted, the applicant will be notified by the California Department of Public Health or the local registrar's office. The notification will detail the reasons for rejection, which may include incomplete information, lack of necessary documentation, or non-compliance with prescribed guidelines. Applicants may have the opportunity to submit additional information or clarify discrepancies to fulfill the requirements for amending the record.

Common mistakes

  1. Filling out the form in an ink color other than black causes processing delays, as the form specifically instructs to type or print clearly in black ink only. This mistake might lead to the rejection of the application because the form also becomes an actual part of the official record, making legibility and adherence to instructions crucial.

  2. Introducing erasures, whiteouts, or making alterations on the form is a common error. The instructions clearly prohibit these actions because they can compromise the integrity of the official record. Any mistake made while filling out the form should be addressed by starting anew on a clean form to avoid confusion and ensure the accuracy of the archives.

  3. Submitting photocopies of the original amendment form instead of the original document itself is another mistake. The documentation requires original submissions as photocopies may not capture all details accurately, and original signatures are needed to verify the authenticity of the application.

  4. Not completing Part I of the form with the information exactly as it appears on the current certificate can lead to the amendment being rejected. Accuracy in this section is vital for locating the original record that needs to be amended.

  5. Only one item should be listed per line in Part II, Item 8, but often applicants list multiple corrections in one line. This mistake can cause confusion and potentially lead to only one of the requested amendments being processed.

  6. Entering incorrect information in Item 9 (incorrect information that appears on the current record) or Item 10 (corrected information as it should appear) can significantly delay processing. It's essential to carefully review the current record and the correction being requested to ensure accuracy.

  7. Failure to include the reason for correction in Item 11, or providing a vague explanation, can result in the amendment application being questioned or rejected. Clear and concise reasoning helps the assessing officer understand the necessity of the amendment, contributing to a smoother amendment process.

  • The requirement for two signatures on the amendment form underlines the seriousness of the amendment process. Overlooking or neglecting to have both parties sign the document is a critical error that will lead to the application's immediate rejection.

  • Forgetting to include the necessary fee(s) with the amendment form can halt the entire amendment process. Whether it's the processing fee for the application filed more than a year after the event or the fee for additional certified copies of the newly amended record, each has its specified amount that must be accurately enclosed.

  • Not using the correct mailing address when sending the amendment form and fees to the California Department of Public Health Vital Records can cause delays. Ensuring that the package is directed correctly is crucial for timely processing.

Documents used along the form

When working with the VS 24 C form, which is an affidavit to amend a record, various other forms and documents might be necessary to ensure that the amendment process is complete and the updated information is accurately reflected in the official records. These additional forms and documents complement the amendment process by providing required legal attestations, supporting evidence, or additional information that might be needed by the registrar. Understanding these documents helps streamline the amendment process, making it smoother and more efficient.

  • Notarized Sworn Statement: This document is imperative for verifying the identity of the applicant requesting a copy of the amended record. It ensures that the request is legitimate and that the applicant has the right to access the information.
  • Original Birth, Death, or Fetal Death Certificate: The original document is needed for comparison with the amendment request to accurately identify discrepancies and make the necessary corrections.
  • Court Order for Change of Name or Gender: If the amendment involves a change of name or gender, an official court order is required. This document legally authorizes the amendment to vital records.
  • Proof of Relationship: When requesting amendments on behalf of someone else, documents proving a legal or familial relationship to the individual on the record (e.g., marriage certificate, adoption records) are required to establish authority.
  • Medical Records: For amendments related to medical or health information, such as the cause of death, corresponding medical records from a health professional or institution may be necessary as evidence.
  • Guardianship or Power of Attorney Documents: In cases where the individual requesting the amendment is not the person on the record but is acting on their behalf, legal documents establishing guardianship or power of attorney are needed to validate their authority.

In the process of amending vital records such as birth, death, or fetal death certificates, the VS 24 C form serves as the core document. However, the accompanying documents listed above play crucial roles in supporting the amendment request. They provide legal and evidentiary support to ensure that all amendments are justified and properly documented. Whether it's providing proof of identity, legal authority, or the basis for the requested changes, each document helps safeguard the integrity of vital records.

Similar forms

  • The VS 24 C form, designed for amending vital records, bears similarity to the Application for a Social Security Card (Form SS-5). Both documents are used to correct or update personal information officially recorded by government agencies. The SS-5 form allows for the amendment of a Social Security record, including changes to a name or correcting the date of birth, mirroring the VS 24 C’s purpose of amending vital records such as birth, death, or fetal death certificates with accurate details. A pivotal aspect of both forms is their role in ensuring that government records accurately reflect individuals' personal information.

  • Another document resembling the VS 24 C form is the Passport Application Form (DS-11). This form is utilized when individuals need to apply for a new passport, including situations where amending existing information is necessary, such as changes in personal details due to marriage or legal name change. Like the VS 24 C, the DS-11 form requires detailed personal information and evidence to support the requested changes, emphasizing accuracy in official records and personal identification documents.

  • The Application for Marriage License in various states also aligns closely with the VS 24 C form's purpose. Similar to amending birth or death records, applying for a marriage license requires precise and current personal information. Both documents necessitate the submission of accurate details to official state records, underscoring the importance of legal documentation in personal identification and status within public records.

  • Lastly, the Driver License or Identification Card Application (Form DL-44) in California shares key characteristics with the VS 24 C form. Both forms are crucial for updating or correcting personal information with state agencies. The DL-44 form allows for changes to name, date of birth, and other personal details on a driver’s license or ID card, ensuring that these identifiers remain accurate and current, similar to the objectives of the VS 24 C form regarding vital records.

Dos and Don'ts

When completing the VS 24 C form, an affidavit to amend a record such as a birth, death, or fetal death certificate in the State of California, it's crucial to adhere to specific guidelines to ensure the amendment process is valid and error-free. Here’s a comprehensive guide:

Do's:

  1. Use black ink only when completing the form. This ensures readability and compliance with regulations.
  2. Make sure all information provided matches exactly with what is currently on the record. Accuracy is essential for verifying the amendment.
  3. List only one item per line in Part II, where you're stating which information needs correction. This helps in keeping the amendment process organized and clear.
  4. Enter both the incorrect information that currently appears on the record and the corrected information as it should appear after the amendment. Clarity here prevents any misunderstandings or processing delays.
  5. Provide a reason for each correction in the space provided. This justifies the need for each amendment made to the record.
  6. Ensure that two individuals sign the form, confirming the truth and accuracy of the information provided for the correction. Their signatures validate the request.
  7. Submit the original amendment form only, as photocopies are not accepted. This maintains the integrity of the amendment process.
  8. Enclose the correct fee for processing, keeping in mind that fees may vary depending on the time elapsed since the event occurred and the number of copies requested.

Don'ts:

  1. Do not attempt to alter the original certificate in any way. Erasures, whiteouts, photocopies, or any alterations to the form are strictly prohibited and can invalidate your application.
  2. Refrain from using any ink colors other than black, as this could lead to rejection of the application.
  3. Avoid listing more than one item per line in Part II to prevent confusion and ensure that each amendment is clearly documented.
  4. Do not leave out the incorrect information currently on record or the corrected information. Both pieces of information are crucial for processing the amendment.
  5. Do not forget to state the reason for each correction. This explanation is essential for the proper handling of your request.
  6. Do not submit the form without the necessary signatures, as unsigned forms will not be processed.
  7. Never submit a photocopy of the amendment form. Only the original document is acceptable.
  8. Avoid enclosing incorrect processing fees, as this can delay the amendment process.

Misconceptions

When navigating the complexities of amending vital records, individuals often encounter misunderstandings about the process and requirements. The Affidavit to Amend a Record, known as the VS 24 C form, is essential in this procedure. Misconceptions about this form can lead to confusion and delays. Here, we aim to clarify and address these common errors.

Misconception 1: The original certificate can be altered.

Many believe that the original birth, death, or fetal death certificate can be directly modified. However, the VS 24 C form procedure does not alter the original certificate. Instead, any amendment made becomes a part of the original record, complementing it without changing the original document.

Misconception 2: Digital submissions are accepted.

A common assumption is that amendments can be submitted electronically. The instructions specify that only the original amendment form in black ink will be accepted, highlighting the requirement for physical documents over digital or copied submissions.

Misconception 3: Erasures, whiteouts, or photocopies are permitted.

There is a strict prohibition against erasures, whiteouts, photocopies, and alterations on the form. This rule ensures the integrity and clarity of the record amendment submission, which must be adhered to meticulously.

Misconception 4: Any witness can sign the affidavit.

The form specifies that two persons with personal knowledge of the corrected information must sign it. This is not just any witness but individuals who can certify the accuracy of the new details provided on the form.

Misconception 5: There is always a fee required to submit the form.

This misunderstanding ignores the stipulation that if an acceptable application to amend the record is registered within one year of the event date, no processing fee is charged for the amendment itself, though a fee for a certified copy may still apply.

Misconception 6: Amendments are processed immediately.

The processing of amendments can take time, and an immediate turnaround should not be expected. The form must first be submitted and accepted by the California Department of Public Health Vital Records or Local Registrar, a process involving verification and registration.

Misconception 7: Any type of ink can be used on the form.

The instructions specifically state that the amendment form should be filled out in black ink only. This requirement is to ensure legibility and uniformity in official records management.

Misconception 8: The amendment process is entirely online.

While some preliminary information might be available online, the VS 24 C form process involves filling out a physical document and mailing it with the appropriate fee to the California Department of Public Health Vital Records. This hybrid approach counters the belief that the process can be completed entirely online.

Misconception 9: Once amended, the original record is replaced.

A notable misconception is that the amendment process results in the original record being replaced or discarded. In reality, the amendment adds to the existing record, with both documents needing to remain together to reflect the complete and accurate history of the event.

Key takeaways

Filling out and using the VS 24 C form, an Affidavit to Amend a Record, requires careful attention to detail and adherence to specific guidelines set by the California Department of Public Health - Vital Records. Here are key takeaways for a successful amendment process:

  • The original certificate cannot be altered in any way. Instead, amendments are added to the original record.
  • It is imperative to use black ink and ensure that the handwriting is clear, as these amendments become a part of the official record.
  • Submission of original amendment forms is mandatory; photocopies are not accepted, underscoring the importance of accuracy in the initial filing.
  • A certified copy of the amended record includes both the original certificate and the amendment, which must be kept together to remain valid.
  • Requesting a certified authorized copy of the amended certificate mandates a Notarized Sworn Statement, ensuring the requester has a legal right to the information.
  • No alterations to the form, including erasures or whiteouts, are allowed, highlighting the need for precision in filling it out.
  • Details must match exactly as they appear on the current certificate for Part I, ensuring consistency and accuracy in the record.
  • Each correction must be listed separately, with incorrect and correct information clearly noted, facilitating a clear understanding of the changes made.
  • The reason for every correction must be provided, explaining the basis for the requested amendments.
  • Two individuals with personal knowledge of the facts must sign the affidavit, attesting to the accuracy of the information provided under penalty of perjury.

The process includes a fee structure that varies depending on the timing of the amendment submission relative to the date of the event recorded. These fees cover filing and obtaining certified copies, with specific amounts and additional copies carrying separate charges. This information, along with the completed form and necessary payment, should be directed to the California Department of Public Health Vital Records - Amendments section, ensuring the proper processing and amendment of vital records while maintaining their integrity and veracity.

Please rate Vs 24 C Template Form
4.5
(Exceptional)
2 Votes

Create More Documents