APPLICATION TO CHANGE AN ALABAMA BIRTH OR DEATH CERTIFICATE

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AMENDMENT PACK ET FOR ALABAMA BIRTH AND DEATH CERTIFICATES This pack et provides information to begin the process of changing or correcting an Alabama birth or death certificate. In most cases, additional documentation or a court order will be required. Birth Certificates  Amendments (C hanging/Correcting a Birth Certificate) – Application 1 Information on a birth certificate entered in error when the birth certificate was originally prepared may be corrected through an amendment process as specified by law. Legal documentation or court action may be required to process the amendment. The fee to amend a birth certificate is $20.00 which includes one certified copy of the amended birth certificate. Additional copies of the same record ordered at the same time are $6.00 each. There is an additional fee of $15.00 to expedite a request.  Legitimations (Adding the Father to a Child’s Birth Certificate) – Application 2 Legitimations establish the legal father of a child, allow the father’s name to be added to a child’s birth certificate, and in some cases allow the child’s name to be changed. The following four (4) legitimation methods are legal procedures and can be us ed only if legal requirements are met. Documentation in addition to the attached application will be required to change a birth record through any legitimation process. 1. Probate Court Legitimations are processed by the Probate Courts. 2. Legitimations throug h Marriage are processed by the Center for Health Statistics. 3. Acknowledgments of Paternity are processed by the County Department of Human Resources or the Center for Health Statistics. 4. Paternity Determinations are processed by the Circuit Courts (Juvenile Division) under the Uniform Parentage Act. Note: In some cases, a court determination can remove a father from a child’s birth certificate. The fee to prepare the new birth certificate following legitimation is $2 5.00 which includes one certified copy of the new birth certificate. Additional copies of the same record ordered at the same time are $6.00 each. There is an additional fee of $15.00 to expedite a request.  Adoptions – Application 3 When an adoption is finalized in court, information on the birth certificate , such as the child’s name and the parents’ names , can be changed. Court documentation in addition to the attached application will be required to change a birth record after an adoption occurs. The fee to prepare the new birth certificate following adoption is $25.00 which includes one certified copy of the new birth certificate. Additional copies of the same record ordered at the same time are $6.00 each. There is an additional fee of $15.00 to expedite a request. To request a birth amendment or a new birth certificate following legitimation or adoption, complete the appropriate application provided in this pack et and indicate the specific changes to be made to the birth certificate. Mail the completed application with valid identification and the appropriate fee to: Center for Health Statistics Special Services Division P.O. Box 5625 Montgomery, A labama 36103- 5625 If you have any questions regarding changes to a birth certificate , call 334.206.2637. ADPH -HS -33/Rev. 05/01 /2019 Death Certificates  Changes /Corrections to the Personal/Demographic Information – Application 1 Personal/demographic information may be corrected through the amendment process by the funeral home, the informant, an immediate family member listed on the record or others with an appropriate legal interest . The “Application to Change an Alabama Birth or Death Certificate” should be completed , indicating the changes to be made to the death certificate. Legal documentation or court action may be required to process the amendment. The original information on the death certificate will not be changed. The amendment will be an affidavit issued with the original certificate indicating the items which were corrected. The fee to amend a death certificate is $20.00 which includes one certified copy of the certificate. Additional copies of the same record ordered at the same time are $6.00 each. There is an additional fee of $15.00 to expedite a request. Mail the completed application referenced above with valid identification and the appropriate fee to the address provided in item #3 bel ow.  Changes/Corrections to the Medical Certification Information; the Date of Death/Pronouncement; and/or Time of Death/Pronouncement Only the certifier (physician, certified registered nurse practitioner, certified nurse midwife, coroner or medical examiner ) who signed the death certificate may make c hanges /corrections to this information on the death certificate. The application referenced above cannot be used to request changes/ corrections to these items. However, instructions for requesting thes e changes/ corrections are listed below. 1. Changing a Cause of Death from “Pending” When the certifier receives the autopsy report, he/she should complete a Supplemental Medical Certification . 2. Changing Information on a Cause of Death or Other Changes to the Medical Certification Section The certifier may mak e changes or corrections to the medical certification section of the death certificate by completing a Supplemental Medical Certification . 3. Completing a Supplemental Medical C ertification In most cases when the death certificate was filed through the Electronic Death Registration System (EDRS) , the certifier may be able to complete an electronic Supplemental Medical Certification through EDRS . If the certifier needs to complete a paper Supplemental Medical Certification, he/she should contact the Center for Health Statistics at 334.206.2641 to request a Supplemental Medical Certification Request Form (HS -90) or fax a request to 334.206. 2659. When the Supplemental Medical Certification Request Form has been completed, it should be mailed to: Center for Health Statistics Special Services Division Death Amendment Clerk P.O. Box 5625 Montgomery, Alabama 36103- 5625 4. Changing a Date of Death/Pronouncement and/or Time of Death/Pronouncement The certifier must submit a signed and dated business letter providing sufficient information to locate the death certificate and the specific changes which should be made to the death certificate. Due to the legal issues involved with the amendment of some items, questions regarding amendment s to a death certificate should be referred to 334.206.2641. ADPH -HS -33/Rev. 05/01/2019 APPLICATION TO CHANGE AN ALABAMA BIRTH OR DEATH CERTIFICATE The fee to amend (correct) an Alabama birth or death certificate is $20.00 which includes one certified copy of the amended c ertificate. The fee for Paternity Determination s (Legitimations) and/or Adoptions is $25.00 which includes one certified copy of the new certificate. Additional copies of the same record ordered at the same time are $6.00 each. There is an additional fee of $15.00 to expedite a request. Make check or money order payable to "State Board of Health." Do not send cash. Fees are non -refundable. Indicate the type of certificate you are requesting to be corrected. PRINT the information identifying the certificate in the appropriate section. Only one r equest may be made per form. You must complete and sign the applicant section or your request cannot be processed. If 19 years of age or older, the record holder must sign the applica tion when requesting changes to his or her birth certificate . MAIL THIS COMPLETED FORM WITH VALID IDENTIFICATION AND APPROPRIATE FEE TO: Center for Hea lth Statistics P.O. Box 5625, Montgomery, Alabama 36103-5625 Visit our website at: www.alabamapublichealth.gov/vitalrecords . Birth Certificate Amendments (corrections) may be requested using this form. For further information, call a Birth Amendment Clerk at 334.206.2637. Refer to the attached Birth Certificate Amendment i nstructions. In most cases, additional documentation or a court order will be required. SEE ID REQUIREMENTS ON REVERSE SIDE. __ BIRTH FULL NAME A S O N BIRTH CERTIFICA TE ________________________________________________________________________________ First Middle Last DATE OF BIRTH _________________________________________ SEX _________________________________________ Number of Copies COUNTY OF BIRTH ___________________________ HOSPITAL _______________________________________________ Requested FULL NAME OF MOTHER /PARENT BEFORE FIRST MARRIAG E _____________________________________________________________________________ _________ FULL NAME OF FATHER /PARENT BEFORE FIRST MARRIAGE _____________________________________________________________________________ What changes are you requesting ? _____________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Death Certificate Amendments ( corrections) to the personal/ demographic info rmation ONLY may be requested using this form. Questions regarding changes or corrections to the medical certification section should be referred to the Death Amend ment Clerk at 334.206.2641. Refer to the attached Death Certificate Amendment i nstructions. In most cases, additional documentation or a court order will be required. SEE ID REQUIRE MEN TS ON REVERSE SIDE. __ DEATH LEGAL NAME OF DECEASED ___________________________________________________________________________ First Middle Last DATE OF DEATH ___________________________ SSN__________________________________ RACE_______________ Number of Copies SEX__________ DATE OF BIRTH ___________________ ________ COUNTY OF DEATH ___________________________ Requested FULL NAME OF MOTHER /PARENT BE FORE FIRST MARRIAGE _____________________________________________________________________________ _________ FULL NAME OF FATHER /PARENT BE FORE FIRST MARRIAGE _____________________________________________________________________________ Starting with 1991 deaths, certificates may be issued without a cause of death. Indicate the number of copies of each type of certificate you want: __________WITH CAUSE OF DEATH _________WITHOUT CAUSE OF DEATH What changes are you requesting? ______________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ APPLICANT SECTION (THIS SECTION MUST BE COMPLETED ) Birth certificates less than 125 years old and death certificates less than 25 years old are restricted records. Valid identification must be submitted with a request to change a birth or death certificate . Anyone falsely applying for a record is subject to a penalty upon conviction of up to three months in the county jail or a fine of up to $500. (Code of Ala bama 1975, § 13A -10-109). By signing, you are certifying you have a legal right to the record requested. Your Signature _________________________________________________________________________ Date __________________________________ Print Your Name _________________________________________________________________ Amount Enclosed $ _____________________________ Your Relationship to Person Whose Record is Being Requested _________________________________________________________________________ Mail to Name (if Different from You) _______________________________________________________________________________________________ Mailing Address _______________________________________________________________________________________________________________ City __________________________________________ State ____________ Zip __________________ Daytime Phone ( ) ___________________ I allow the following individual to receive the certificate(s) ______________________________________________________________________________ ADPH- HS -33/Rev. 0 5/01 /2019 IDENTIFICATION REQUIREMENTS FOR RESTRICTED ALABAMA VITAL RECORDS Identification is required of any applicant requesting a restricted Alabama vital record (birth certificate less than 125 years from the date of birth or death certificate less than 25 years from the date of death). The applicant must submit a completed r equest and one form of identification from the Primary ID list below. In the event the applicant is unable to provide identification from the Primary ID list, he/she may provide two different forms of identification from the Secondary ID list. If the applicant designates another individual to pick up a restricted certificate on his/her behalf, both the applicant and the designee must provide acceptable identification. The completed request, as well as a copy of all identification submitted, will be maint ained by the vital records office which processes the request. Primary IDs Including PHOTO (need at least one, current, expired no more than 60 days) Secondary IDs (need at least two) - Alabama Driver’s License - Out -of-State Driver’s License - State -Issued Non -Driver ID - U.S. or Foreign Passport - U.S. Certificate of Naturalization - Certificate of Citizenship - U.S. Military ID - Work ID (If applicant is employee of agency/company mak ing request) - Alien Resident Card (Temporary or Permanent) - U.S. Employment Authorization Card - Citizenship ID Card - Tribal ID - Pilot’s License - Boating License - Concealed Weapons License - Ex-Felon ID - Inmate ID issued by the U.S. Dept of Justice w/ following docum entation: o Supporting documents from institution if inmate is still in custody, letter of release from institution if inmate has been released - School ID (Must include current school term) - Alabama Voter Identification Card - Expired, Government -Issued ID - Utility Bill (No more than 6 months old) - Work ID (If applicant is making personal request) - Vehicle Registration or Vehicle Title - Property Tax Bill - Military Discharge (DD Form 214) - Voter Registration Card - Health Insurance Card - Social Security Correspondence (not Card) - U.S. Selective Service Card - Recent DMV Receipt for Fines Paid - Fishing or Hunting License - Copy of Police Report or other official documents which support theft, in cases where individual’s ID has been stolen - Autism Spectrum Card - Immunization (Shot) Record * In special cases where applicant is unable to provide any of these documents, please contact CHS at 334.206.5418. APPLICATION TO ADD FATHER TO CHILD’S ALABAMA BIRTH CERTIFICATE Please complete this form to add the father’s information to the birth certificate of the child listed below. Before we begin to process your request, additional information , valid identification (see reverse side) and/or documents are needed. Please answer the following questions and prov ide the documents as indicated when you return this form. After reviewing the information you provide, we will advise you if other documents will be required or if a court action is needed. If you are not a parent of the child or if you do not have legal custody of the child, we may not be able to process your request. The fee to prepare the new birth certificate is $25.00 which includes one certified copy of the new birth certificate. Additional copies of the same record ordered at the same time are $6.00 each. There is an additional fee of $15.00 to expedite a request. Make check or money order payable to “State Board of Health.” Do not send cash. Fees are not refundable if the action cannot be completed due to non-receipt of the required documents . However, we will return the fee if we determine you are not legally authorized to make the request. INFORMATION ON APPLICANT (THIS SECTION MUST BE COMPLETED) Valid identification must be submitted with a request to change a birth certificate. Anyone falsely applying for a record is subject to a penalty upon conviction of up to three months in the county jail or a fine of up to $500. (Code of Ala bama 1975, § 13A -10 -109) . By signing, you are certifying you have a legal right to the record requested . Your Signature _______________________________________________________ Date ______________________________________ Print Your Name _________________________________________ Number of Copies ___________ Amount Enclosed $ _____________ Your Relationship to Child _________________________________________________________________________________________ Mail to Name (if Different from You) _________________________________________________________________________________ Mailing Address _________________________________________________________________________________________________ City ________ ____________ ___________ State ________ Zip ________________ Daytime Phone (_____ ) ______________________ I allow the following individual to receive the certificate(s) ________________________________________________________________ INFORMATION TO LOCATE CHILD’S BIRTH CERTIFICATE CHILD’S FULL NAME AS SHOWN ON BIRTH CERTIFICATE ____________________________________________________________ First Middle Last CHILD’S DATE OF BIRTH ___ ______________ ____ ________ CHILD’S COUNTY OF BIRTH ________________________________________ MOTHER’S FULL NAME BEFORE FIRST MARRIAGE ___________________________________________________________________________ MOTHER’S LEGAL NAME AT TIME OF BIRTH __________________________________________________________________________________ INFORMATION REGARDING CHILD’S PARENTAGE 1. Do you want the father’s name added to the child’s birth certificate? _______ Yes _______No 2. Do you want to change the child’s name on the birth certificate when you add the father’s name? _______ Yes _______No 3. Was the mother married to anyone at the time of the child’s birth, or within 300 days before the child’s birth? _______Yes _______No 4. Have the father and mother married since the child was born? If Yes, send a certified copy of the m arriage certificate. _______Yes _______No 5. Has an individual ever claimed to be the father of this child in court? If Yes, send a certified copy of the court order. _______Yes _______No 6. Has the child support court or any other type of court ever declared an individual to be the father of this child? If Yes, send a certified copy of the court order. _______Yes _______No 7. Has a court established legal custody for this child? If Yes, send a certified copy of the custody order. _______Yes _______No 8. What is the f ather’s name, date of birth and state of birth? Father’s Name ____ _____________________________________ Father’s Date of Birth ______________ __ Father’s State of B irth _______ MAIL THIS COMPLETED FORM WITH VALID IDENTIFICATION AND APPROPRIATE FEE TO: Center for Health Statistics Attn: Legitimations P. O. Box 5625 Montgomery, A labama 36103 -5625 If you have any questions, call 334.206.2637. Visit our website at: www.a labamapublichealth.gov /vitalrecords . ADPH -HS -75/ Rev. 0 5/01/ 2019 IDENTIFICATION REQUIREMENTS FOR RESTRICTED ALABAMA VITAL RECORDS Identification is required of any applicant requesting a restricted Alabama vital record (birth certificate less than 125 years from the date of birth or death certificate less than 25 years from the date of death). The applicant must submit a completed r equest and one form of identification from the Primary ID list below. In the event the applicant is unable to provide identification from the Primary ID list, he/she may provide two different forms of identification from the Secondary ID list. If the applicant designates another individual to pick up a restricted certificate on his/her behalf, both the applicant and the designee must provide acceptable identification. The completed request, as well as a copy of all identification submitted, will be maint ained by the vital records office which processes the request. Primary IDs Including PHOTO (need at least one, current, expired no more than 60 days) Secondary IDs (need at least two) - Alabama Driver’s License - Out -of-State Driver’s License - State -Issued Non -Driver ID - U.S. or Foreign Passport - U.S. Certificate of Naturalization - Certificate of Citizenship - U.S. Military ID - Work ID (If applicant is employee of agency/company mak ing request) - Alien Resident Card (Temporary or Permanent) - U.S. Employment Authorization Card - Citizenship ID Card - Tribal ID - Pilot’s License - Boating License - Concealed Weapons License - Ex-Felon ID - Inmate ID issued by the U.S. Dept of Justice w/ following docum entation: o Supporting documents from institution if inmate is still in custody, letter of release from institution if inmate has been released - School ID (Must include current school term) - Alabama Voter Identification Card - Expired, Government -Issued ID - Utility Bill (No more than 6 months old) - Work ID (If applicant is making personal request) - Vehicle Registration or Vehicle Title - Property Tax Bill - Military Discharge (DD Form 214) - Voter Registration Card - Health Insurance Card - Social Security Correspondence (not Card) - U.S. Selective Service Card - Recent DMV Receipt for Fines Paid - Fishing or Hunting License - Copy of Police Report or other official documents which support theft, in cases where individual’s ID has been stolen - Autism Spectrum Card - Immunization (Shot) Record * In special cases where applicant is unable to provide any of these documents, please contact CHS at 334.206.5418. APPLICATION TO REQUEST A NEW BIRTH CERTIFICATE AFTER ADOPTION When a child is adopted through an Alabama court, the court forwards the order of adoption and information showing the child’s new name and the names of the new parents to the Center for Health Statistics in Alabama. Upon receipt of the information, the Center for Health Statistics will do one of the following depending upon where the child was born: IF THE ADOPTED CHILD WAS BORN IN ALABAMA: • The Center for Health Statistics will prepare a new birth certificate for the child showing the new names. • The fee to prepare the new certificate of birth after adoption is $25.00 which includes one certified copy of the new record. Additional copies of the same record ordered at the same time are $6.00 each. There is an additional fee of $15.00 to expedite a reques t. • To obtain a copy of the child’s new bi rth certificate, complete the application form below. Valid identification must be submitted with a request for a new Alabama birth certificate after adoption . See the identification requirements on the reverse side. IF THE ADOPTED CHILD WAS BORN IN ANOTHER STATE : • The new birth certificate for the child must be prepared in the state where the child was born. • The fee for the Center for Health Statistics to forward the order of adoption to the child’s state of birth is $10.00. • Upon receipt of the fee, t he Center for Health Statistics will forward the court order of adoption and the information showing the new name to the appropriate vital records office in the state where the child was born. • You will need to contact the state of birth for a copy of the n ew certificate. Make check or money order payable to “State Board of Health.” Do not send cash. Fees are non -refundable. Complete the application below and send with the required documents and appropriate fee to: Center for Health Statistics Attn: Adoption s P.O. Box 5625 Montgomery, A labama 36103-5625 Please allow 2-4 weeks after the court action has been completed before mailing your request , valid identification (if requesting an Alabama birth certificate) and fee. If this is an adult adoption or you have additional questions, call 334.206. 2637. Vis it our website at www.alabamapublichealth.gov/vitalrecords. IF THE CHILD WAS BORN IN A FOREIGN COUNTRY, DO NOT COMPLETE THIS FORM. Call 334.206. 2637 for additional information and appropriate forms. FULL NAME OF CHILD BEFORE ADOPTION (IF KNOWN) ____________________________________________________________________________ First Middle Last FULL NAME OF CHILD AFTER ADOPTION ________________________________________________________________________________________ First Middle Last STATE OF BIRTH ______________________________________COUNTY OF BIRTH ______________________________________________________ DATE OF BIRTH _________________________________________________ SEX ________________________________________________________ FULL NAME OF ADOPTIVE MOTHER/PARENT BEFORE FIRST MARRIAGE _____________________________________________________________________________________________________ FULL NAME OF ADOPTIVE FATHER/PARENT BEFORE FIRST MARRIAGE _____________________________________________________________________________________________________ APPLICANT SECTION (THIS SECTION MUST BE COMPLETED) If Alabama Birth, Number of Copies ______________ Amount Enclosed $ ________________ Valid identification must be submitted with a request to change a birth certificate. Anyone falsely applying for a record is subject to a penalty upon conviction of up to three months in the county jail or a fine of up to $500. (Code of Ala bama 1975, § 13A -10-109) . By signing, you are certifying you have a legal right to the record requ ested. Your Signature ____________________________________________________________ __________ Date _____________________________________ Print Your Name ______________________________________________________________________________________________________________ Your Relationship to Child _______________________________________________________________________________________________________ Mail to Name (if Different from You) _______________________________________________________________________________________________ Mailing Address __________________________________________________________________________________________________ City _________________________________ State _____________ Zip _________________ Daytime Phone (_________) _________________________ I allow the following individual to receive the certificate(s) ______________________________________________________________________________ ADPH -HS -88/R ev . 05/01/2019 IDENTIFICATION REQUIREMENTS FOR RESTRICTED ALABAMA VITAL RECORDS Identification is required of any applicant requesting a restricted Alabama vital record (birth certificate less than 125 years from the date of birth or death certificate less than 25 years from the date of death). The applicant must submit a completed request and one form of identification from the Primary ID list below. In the event the applicant is unable to provide identification from the Primary ID list, he/she may provide two different forms of identification from the Secondary ID list. If the applicant designates another individual to pick up a restricted certificate on his/her behalf, both the applicant and the designee must provide acceptable identification. The completed request, as well as a copy of all identific ation submitted, will be maintained by the vital records office which processes the request. Primary IDs Including PHOTO (need at least one, current, expired no more than 60 days) Secondary IDs (need at least two) - Alabama Driver’s License - Out -of-State Driver’s License - State -Issued Non -Driver ID - U.S. or Foreign Passport - U.S. Certificate of Naturalization - Certificate of Citizenship - U.S. Military ID - Work ID (If applicant is employee of agency/company making request) - Alien Resident Card (Temporary or Permanent) - U.S. Employment Authorization Card - Citizenship ID Card - Tribal ID - Pilot’s License - Boating License - Concealed Weapons License - Ex-Felon ID - Inmate ID issued by the U.S. Dept of Justice w/ following documentation: o Supporting documents from institution if inmate is still in custody, letter of release from institution if inmate has been released - School ID (Must include current school term) - Alabama Voter Identification Card - Expired, Government -Issued ID - Utility Bill (No more than 6 months old) - Work ID (If applicant is making personal request) - Vehicle Registration or Vehicle Title - Property Tax Bill - Military Discharge (DD Form 214) - Voter Registration Card - Health Insurance Card - Social Security Correspondence (not Card) - U.S. Selective Service Card - Recent DMV Receipt for Fines Paid - Fishing or Hunting License - Copy of Police Report or other official documents which support theft, in cases where individual’s ID has been stolen - Autism Spectrum Card - Immunization (Shot) Record * In special cases where applicant is unable to provide any of these documents, please contact CHS at 334.206.5418.