Homepage Free Vs 24 C PDF Template
Outline

The VS 24 C Form, also known as the "Affidavit to Amend a Record," plays a crucial role in the accuracy and integrity of vital records in the state of California. Designed to correct or update birth, death, or fetal death records, this form ensures that significant life events are accurately documented. Meticulously crafted to prevent unauthorized changes, the form specifies no erasures, whiteouts, photocopies, or alterations, emphasizing the importance of accuracy in the submission process. Information required includes current details on the record and the corrected data, alongside a compelling reason for the amendment. Completing this affidavit involves a clear understanding of the existing record, as two individuals with personal knowledge of the facts must sign, under penalty of perjury, verifying the accuracy of the new information. The form's design reflects a balance between rigidity to prevent fraud and flexibility to ensure life events are accurately recorded. It becomes an integral part of the official record once submitted, highlighting its significance in maintaining the veracity of official documents. Moreover, the form delineates the financial aspect of amendments, noting that fees vary depending on when the application is submitted relative to the date of the event in question. This system underscores the importance of timely record accuracy while also accommodating necessary changes as they arise. The VS 24 C form, therefore, represents more than a mere bureaucratic necessity; it is a safeguard for the historical accuracy of personal records, ensuring that individuals' life milestones are correctly documented for generations to come.

Document 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

Document Attributes

Fact Name Description
Purpose The form is used to amend a birth, death, or fetal death record in California.
Requirements for Amendments Amendments must be typed or printed in black ink, and the form prohibits erasures, whiteouts, photocopies, or alterations.
Fees There is no processing fee if the amendment is filed within one year of the event. After one year, fees apply for filing the affidavit and for additional certified copies.
Governing Law Amendments are governed by the California Department of Public Health - Vital Records regulations.

How to Fill Out Vs 24 C

Amending a record is a significant process to ensure that official documents accurately reflect the truth. Whether it's a birth, death, or fetal death record that needs correction, the State of California provides a structured way to make these changes through the VS 24 C form. It's crucial to approach this task with attention to detail, as the amendment becomes an integral part of the official record. Here are systematic instructions for completing the VS 24 C form, a vital step toward rectifying a piece of vital information. Remember, accuracy in filling out this form not only rectifies errors but also adheres to legal documentation standards.

  1. Gather the necessary information: Ensure you have all the details as they appear on the current record and the correct information that should be on the record.
  2. Use black ink: Fill out the form using black ink only to ensure clarity and legibility. This is important for the document to be officially recorded and recognized.
  3. Complete Part I: Enter the information as it currently appears on the record, covering items 1 through 7. This part requires the original information to locate the record accurately.
  4. Specify the corrections in Part II: For each correction, list the item number (Item 8), the incorrect information as it currently appears (Item 9), and the corrected information as it should appear (Item 10).
  5. State the reason for each correction: In Item 11, clearly articulate why each correction is being made. This provides context and justifies the need for the amendment.
  6. Sign the affidavit: Two individuals with personal knowledge of the facts must sign and print their names, state their relationship or title in relation to the person on the record (Item 12 and 13), and provide their address and the date signed. This attests to the truthfulness and accuracy of the correction.
  7. Payment: Determine if a fee is applicable based on the timing of the amendment submission related to the date of the event. Ensure to include the correct fee amount for processing or for obtaining certified copies of the amended record.
  8. Review the form: Double-check all entries for accuracy and completeness. Remember, no erasures, whiteouts, photocopies, or alterations are allowed.
  9. Mail the form and payment: Send the completed VS 24 C form along with any required fees to the California Department of Public Health Vital Records - Amendments. The address is provided on the form itself.

By carefully following these steps, individuals can successfully submit an application to amend a vital record in California. It's imperative to ensure all information provided is accurate and complete to avoid delays or issues with the amendment process. Once the form and any applicable fees are submitted, the amendment will be reviewed and, if accepted, become an official part of the record. This meticulous process safeguards the integrity of vital records and ensures that they accurately reflect the truth.

More About Vs 24 C

  1. What is the VS 24 C form?

    The VS 24 C form, known as the Affidavit to Amend a Record, is a document used in California to request amendments to vital records. These records include birth, death, and fetal death certificates. The form requires detailed information about the current record and the specific changes needed, with the principle that no original certificates can be altered. Instead, this amendment becomes an actual part of the official record.

  2. Who needs to sign the VS 24 C form?

    For a correction to be considered valid, two individuals must sign the VS 24 C form. These signatories certify under penalty of perjury that they have personal knowledge of the facts and believe the information provided for the amendment is true and correct. Each signatory must provide their signature, printed name, title or relationship to the person on record, address, and the date they signed the form.

  3. What information is needed to fill out Part I of the form?

    Part I is designed to gather necessary details to locate the original record in question accurately. You'll need to fill in the name as it currently appears on the record, the sex of the individual, the date and place of the event, and the full names of the parents as stated on the current certificate. Ensuring accuracy in this section helps in identifying and accessing the correct document for amendment.

  4. How should corrections be listed on the VS 24 C form?

    When listing corrections in Part II, it's important to organize information clearly. For each correction, you must include the item number from the original certificate that needs amendment, the incorrect information as it currently appears, and the corrected information as it should appear after the amendment. Each item needing correction should be listed on a separate line to avoid confusion and ensure each amendment is recorded accurately.

  5. What is the process and fee for submitting the VS 24 C form?

    The process involves completing the VS 24 C form with accurate information, signatures from two individuals verifying the amendment, and the applicable fee. If the amendment is registered within one year of the event date, there's no processing fee for the amendment itself, but a fee for a certified copy may apply. For amendments filed more than a year after the event, a filing fee will be required, which includes one certified copy of the amended record. Additional copies of the amended record will incur extra charges. Fees vary, so it's recommended to contact the California Department of Public Health - Vital Records or visit their website for the most current information.

  6. What should you do after completing the VS 24 C form?

    After filling out the form and obtaining the necessary signatures, you should review your application to ensure all information is complete and accurate. Then, attach the required fee(s) and mail everything to the California Department of Public Health Vital Records - Amendments section at the address provided on the form. Remember, the application must be original as photocopies are not accepted. Completing these steps will start the process of amending the vital record in question.

Common mistakes

Filling out the VS 24 C form, titled the Affidavit to Amend a Record, can be a straightforward process if due attention is given to detail. However, individuals often encounter pitfalls that can delay or complicate the amendment process. Here are four common mistakes:

  1. Using incorrect ink or making alterations:
    • The form mandates the use of black ink for a reason; it ensures legibility and uniformity across all documents. People sometimes use different ink colors or pencils, which can lead to the rejection of the form. Additionally, making erasures, using whiteout, or making alterations on the form is not permitted. All entries must be final and clear, as the form becomes an actual part of the official record.

  2. Submitting photocopies instead of the original form:
    • A critical detail that applicants overlook is the requirement to submit the original amendment form. Photocopies, regardless of how clear they may be, are not accepted. This is because the original form becomes a part of the official amended record, and maintaining the authenticity of documents is crucial in official record-keeping.

  3. Incomplete or inaccurate information:
    • Completing every section of Part I with the correct information as it currently appears on the record is essential. It is a common oversight to incorrectly fill out the names of parents as stated on the current record or to provide inaccurate dates. These errors can significantly delay the amendment process, as accuracy is paramount in official records to prevent fraud and ensure the integrity of data.

  4. Failure to include the correct fee or ignoring the timing of the submission:
    • Depending on when the amendment is filed relative to the date of the event, the required fee can differ. Forgetting to include the appropriate fee—whether it's for filing the affidavit itself or for requesting additional certified copies of the newly amended record—can result in processing delays. Additionally, not taking advantage of the fee waiver available for amendments submitted within a year of the event is a missed opportunity to save on costs.

By avoiding these common pitfalls, individuals seeking to amend a record can ensure a smoother process, leading to the timely acceptance and processing of their form VS 24 C.

Documents used along the form

When handling the process of amending a vital record in California, several documents may accompany the VS 24 C form, otherwise known as the Affidavit to Amend a Record. These documents are crucial for the successful amendment of a vital record, ensuring that all information is accurate and up-to-date. The paperwork varies based on the specifics of the amendment, but here are some common forms and documents that are often used in conjunction with the VS 24 C form.

  • Notarized Sworn Statement – This is a document that confirms the identity of the applicant and ensures that the information provided is true under oath. It's especially necessary when requesting a certified authorized copy of the amended certificate.
  • Birth Certificate Application Form – If the amendment involves a birth record, an application for a new birth certificate might be required to issue a revised document reflecting the changes made.
  • Death Certificate Application Form – Similarly, for amendments pertaining to a death record, a new application for the death certificate helps in reissuing an updated copy with the amendments.
  • Proof of Identity – This could include a photocopy of a driver’s license, state-issued ID, or passport of the individual requesting the amendment to verify their identity.
  • Fee Schedule and Payment Form – Since there are specified fees for filing the affidavit and obtaining additional certified copies of the amended record, a completed fee schedule and the associated payment form or information are necessary.
  • Documentation Supporting the Amendment – This could encompass a wide range of documents such as court orders, legal name change documents, or other official paperwork substantiating the reason for the amendment.

Completing and submitting the VS 24 C form with the appropriate accompanying documents is a straightforward process that corrects or updates vital records efficiently. Every document plays a significant role in ensuring the amendment is processed correctly, reflecting the accurate and current information as intended. Whether it's to change a name, correct a date, or update parental information, these documents collectively facilitate a smooth amendment process. It's critical to review and gather all necessary paperwork before submission to avoid any delays in processing the amendment.

Similar forms

  • The VS-22 Form - Application to Correct a Vital Record is quite similar to the VS 24 C Form as both involve amending vital records. The primary difference lies in the specific details and circumstances under which each form is utilized, but both require accurate information and authentication by witnesses or officials.

  • Death Certificate Application Form shares similarities with the VS 24 C Form, specifically in the modification aspect related to death records. Both forms necessitate detailed information about the individual and the event, supporting evidence, and official endorsements to process amendments or issue copies.

  • The Application for Marriage Certificate is another document that can be paralleled with the VS 24 C Form, particularly in the process of correcting or amending marriage records. Like the VS 24 C, it demands clear and precise information, along with verification and official stamps to amend the marriage record.

  • An Affidavit to Correct or Amend a Birth Certificate closely aligns with the VS 24 C Form due to its focus on rectifying or updating information on a birth record. The key steps include outlining the incorrect information, providing the corrected details, and obtaining necessary affirmations, similar to the process outlined in the VS 24 C.

  • The Name Change Petition can be considered similar to the VS 24 C Form in terms of legal documentation required to officially change a name on personal records, which might necessitate amendments to vital records such as those detailed in the VS 24 C.

  • Passport Application Forms also bear resemblance to the process delineated in the VS 24 C Form, especially when correcting personal information. Mistakes in vital records that affect passport details necessitate amendments via forms like the VS 24 C to ensure consistency across legal documents.

  • Application for a Social Security Card, specifically when amending or updating information due to errors or changes in life circumstances, shares a procedural semblance with the VS 24 C Form. It underscores the necessity of accurate, legal documentation in altering vital records or personal identification information.

  • Lastly, the Driver’s License Application Form when needing corrections or updates, such as after a name change or other alterations in personal details, reflects the amendment attributes of the VS 24 C Form. It demands precise and verifiable information to ensure legal and official records are consistent and accurate.

Dos and Don'ts

When you set out to complete the VS 24 C form, an affidavit to amend a record, it's crucial you follow specific steps and avoid certain pitfalls to ensure your request is processed smoothly. Below are key do's and don’ts:

  • Do type or print clearly in black ink only. Since the amendment becomes a permanent part of the official record, clarity is non-negotiable.
  • Don’t use erasures, whiteouts, photocopies, or make alterations on the form. These actions can invalidate your submission.
  • Do complete Part I items 1 – 7 with the information exactly as it appears on the current certificate to accurately identify the record needing amendment.
  • Don’t leave out the reason for the correction in Item 11. Your explanation provides context and justification for the requested change.
  • Do ensure that two persons, who have personal knowledge of the facts, sign the form. Their signatures are crucial for validating the correction.
  • Don’t write in Items 14 or 15, as these sections are exclusively for State or Local Registrar use.
  • Do include the correct fee along with your application, understanding the fee structure varies depending on when the amendment is registered relative to the event date.
  • Don’t forget to check your form for accuracy and completeness before submitting it. Incomplete or inaccurate forms can lead to delays or rejection of your amendment request.

Following these guidelines can help ensure the amendment process for your record is as smooth and expedient as possible. If you have questions about the process or need clarification on the form, consider contacting the California Department of Public Health Vital Records for assistance.

Misconceptions

Understanding the VS 24 C form, essential for amending vital records in California, requires clear insight to avoid common misconceptions. This form has specific uses, requirements, and processing details that are often misunderstood. Addressing these misconceptions ensures that the process of amending a record is smooth and successful.

Misconception 1: Photocopies of the VS 24 C Form Are Acceptable

One common misconception is that photocopies of the completed VS 24 C can be submitted for processing. The California Department of Public Health - Vital Records strictly requires the submission of the original amendment form. This stipulation ensures the integrity and official nature of the amendment process. Attempting to submit a photocopy will lead to the rejection of the application, potentially delaying the amendment procedure.

Misconception 2: The Original Certificate Can Be Altered Directly

Another misunderstanding is that the original record itself can be altered. However, the original certificate remains unchanged. The form clearly specifies that the amendment becomes a part of the original record but does not alter the original certificate. This distinction is crucial for preserving historical accuracy while allowing necessary corrections to be officially attached and recognized.

Misconception 3: The VS 24 C Form Allows for Multiple Corrections in One Line

Applicants sometimes believe they can list multiple corrections on a single line of the form. Each correction must be listed separately, in its dedicated line in Part II of the form. This ensures clarity and precision in identifying and documenting each corrected item. Clumping multiple corrections together can lead to processing delays or errors in the amended record.

Misconception 4: Any Relationship to the Person Can Sign the Form

There is also confusion about who can sign the VS 24 C form. It requires signatures from two individuals certifying the corrections, but these signatories must have direct knowledge of the facts and a legal or familial connection to the record subject. Their relationships to the person on the record must be clearly stated, underscoring the importance of their attestations to the correction's validity. Simply having knowledge of the individual is not enough; the relationship must be substantiated and relevant.

Clearing up these misconceptions is essential for anyone needing to navigate the process of amending a vital record in California. By understanding these key points, individuals can effectively correct important records, ensuring their accuracy and reflecting necessary changes.

Key takeaways

When it comes to amending vital records in California, the VS 24 C form plays a crucial role. Understanding the key takeaways about filling out and using this form is important for anyone looking to make changes to birth, death, or fetal death records. Here are some essential points to keep in mind:

  • The original certificate cannot be altered. Any amendments made through the VS 24 C form become part of the original record without altering the original document itself.
  • Type or print clearly in black ink only to ensure that the amendment application is processed without any issues.
  • Only original amendment forms will be accepted. Copies, including those with any erasures, whiteouts, or alterations, will be rejected.
  • Applicants will receive a certified copy that includes both the original certificate and the amendment. These two documents must stay together to keep the certified copy valid.
  • A notarized sworn statement is necessary when requesting a certified copy of the amended certificate. This helps to authenticate the request and protect personal information.
  • Details in Part I need to match the information as it currently appears on the record. Accuracy in this section is crucial for locating the record that needs to be amended.
  • For corrections, specify the item number that needs correction, the incorrect information, and the corrected information clearly and concisely.
  • The form requires signatures from two persons, certifying that the information provided for the correction is accurate. This adds an extra layer of verification to the amendment process.

It's also important to be aware of the fees associated with filing the VS 24 C form. The fees vary depending on when the application is submitted in relation to the date of the event recorded. Direct and prompt communication with the California Department of Public Health or local registrars can provide the most current fee information and any additional guidance needed.

Completing and submitting the VS 24 C form is a process that demands attention to detail. By following these guidelines, applicants can ensure a smoother and more efficient amendment process, ultimately leading to the desired changes in the vital records.

Please rate Free Vs 24 C PDF Template Form
4.5
Excellent
2 Votes