Affidavit to Correct a Certificate of Death or Report of Fetal Death 2025

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  1. Click ‘Get Form’ to open the Affidavit to Correct a Certificate of Death or Report of Fetal Death in our editor.
  2. Begin by filling in your personal information, including your name, relationship to the person on record, address, and phone number. Ensure all details are accurate and clearly printed.
  3. In the 'Original Certificate Information' section, provide the local registrar number, state file number, name as recorded, sex, date of death, and city/county of event. This information is crucial for identifying the correct record.
  4. Next, specify the items you wish to correct. For each item listed, include how it appears on the original certificate and what the correct information should be.
  5. Complete the 'Affidavit of Personal Knowledge' section. This must be signed before a notary. Ensure that all required signatures are obtained and that you have filled in the notary's details accurately.

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You may also: Call the Customer Service Unit at (916) 445-2684. Contact the County Recorder or County Health Department in any California county. The Physician/Certifiers Amendment, VS 24A form, is also available in the same manner as noted above.
The immediate (direct) cause of death is entered on the first line, 1(a). There must always be an entry on line 1(a).
Common errors may include misspelled names, inaccurate dates of birth or death, or incorrect information regarding the cause of death.
The death certificate should include his medical cause of death along with any contributing factors.
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