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- Click ‘Get Form’ to open it in the editor.
- In the upper right-hand corner, enter the Local Registration Number as required.
- Complete Part I by filling in Items 1A to 7 with information exactly as it appears on the original record.
- In Part II, Item 8, list the certificate item number(s) that need correction, ensuring one item per line.
- For Item 9, write down the incorrect information from the original certificate.
- In Item 10, provide the corrected information for each item listed in Item 9.
- State your reason for correction in Item 11.
- Ensure two individuals sign the affidavit statement at the bottom of the form.
- Do not fill out Items 14 and 15; these are reserved for State or Local Registrar use only.
- Submit your completed form along with any required fees to the California Department of Public Health - Vital Records.
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