Form VS140 "Request Vital Records Forms" - California

What Is Form VS140?

This is a legal form that was released by the California Department of Public Health - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the California Department of Public Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form VS140 by clicking the link below or browse more documents and templates provided by the California Department of Public Health.

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Download Form VS140 "Request Vital Records Forms" - California

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State of California-Health and Human Services Agency
California Department of Public Health
Request Vital Records Forms
INSTRUCTIONS
Fill out this form to request California Birth, Death, Fetal Death and Marriage forms and instructions
to be mailed to you. Please allow up to two weeks for delivery by mail.
Step 1: Select forms and instructions to be mailed to you from the list of certified copy request and
amendment forms below.
Step 2: Enter the name and mailing address where the form and instructions are to be sent; please
provide a phone number and email address in the event clarification is needed to mail request.
Step 3: Click the “Submit Request” button (bottom of form) to submit the completed request by
email.
REQUEST CERTIFIED COPY FORMS AND INSTRUCTIONS
Select certified copy request form(s) to be mailed to you, from list below:
☐VS 12-APPLICATION FOR CERTIFIED COPY OF FETAL DEATH RECORD
☐VS 13E-APPLICATION FOR CERTIFIED COPY OF CERTIFICATE OF STILL BIRTH
☐VS 111-APPLICATION FOR CERTIFIED COPY OF BIRTH RECORD
☐VS 112-APPLICATION FOR CERTIFIED COPY OF DEATH RECORD
☐VS 113A-APPLICATION FOR CERTIFIED COPY OF MARRIAGE RECORD
☐VS 113B-APPLICATION FOR CERTIFIED COPY OF DIVORCE RECORD
REQUEST AMENDMENT/OTHER FORMS AND INSTRUCTIONS
Select vital record amendment form(s) to be mailed to you, from list below:
☐VS 21-APPLICATION TO AMEND A BIRTH RECORD-
ADJUDICATION OF FACTS OF PARENTAGE
☐VS 22-ACKNOWLEDGEMENT OF PATERNITY/PARENTAGE
☐VS 23-AMENDMENT OF BIRTH RECORD TO REFLECT COURT ORDER CHANGE OF NAME
☐VS 24-AFFIDAVIT TO AMEND A RECORD (BIRTH, DEATH, FETAL DEATH)
☐VS 24A-PHYSICIAN/CERTIFIER’S AMENDMENT (BIRTH, DEATH, FETAL DEATH)
☐VS 24C-AFFIDAVIT TO AMEND A MARRIAGE RECORD
☐VS 44-COURT REPORT OF ADOPTION
☐VS 85-DELAYED REGISTRATION OF BIRTH
☐VS 105-COURT ORDER DELAYED REGISTRATION OF FETAL DEATH
☐VS 107-SUPPLEMENTAL NAME REPORT-BIRTH
☐VS 108-COURT ORDER DELAYED REGISTRATION OF BIRTH
☐VS 109-COURT ORDER DELAYED REGISTRATION OF DEATH
☐VS 122-COURT ORDER DELAYED CERTIFICATE OF MARRIAGE
☐VS 124-POWER OF ATTORNEY – CALIFORNIA MARRIAGE LICENSE
Mail forms and information to:
Recipient Name
Mailing Address
City, State and Zip code
Phone number
Email address
SUBMIT REQUEST
Click “Submit Request” button, or email the completed form request to:
OVRform@cdph.ca.gov
VS 140 (10/17)
State of California-Health and Human Services Agency
California Department of Public Health
Request Vital Records Forms
INSTRUCTIONS
Fill out this form to request California Birth, Death, Fetal Death and Marriage forms and instructions
to be mailed to you. Please allow up to two weeks for delivery by mail.
Step 1: Select forms and instructions to be mailed to you from the list of certified copy request and
amendment forms below.
Step 2: Enter the name and mailing address where the form and instructions are to be sent; please
provide a phone number and email address in the event clarification is needed to mail request.
Step 3: Click the “Submit Request” button (bottom of form) to submit the completed request by
email.
REQUEST CERTIFIED COPY FORMS AND INSTRUCTIONS
Select certified copy request form(s) to be mailed to you, from list below:
☐VS 12-APPLICATION FOR CERTIFIED COPY OF FETAL DEATH RECORD
☐VS 13E-APPLICATION FOR CERTIFIED COPY OF CERTIFICATE OF STILL BIRTH
☐VS 111-APPLICATION FOR CERTIFIED COPY OF BIRTH RECORD
☐VS 112-APPLICATION FOR CERTIFIED COPY OF DEATH RECORD
☐VS 113A-APPLICATION FOR CERTIFIED COPY OF MARRIAGE RECORD
☐VS 113B-APPLICATION FOR CERTIFIED COPY OF DIVORCE RECORD
REQUEST AMENDMENT/OTHER FORMS AND INSTRUCTIONS
Select vital record amendment form(s) to be mailed to you, from list below:
☐VS 21-APPLICATION TO AMEND A BIRTH RECORD-
ADJUDICATION OF FACTS OF PARENTAGE
☐VS 22-ACKNOWLEDGEMENT OF PATERNITY/PARENTAGE
☐VS 23-AMENDMENT OF BIRTH RECORD TO REFLECT COURT ORDER CHANGE OF NAME
☐VS 24-AFFIDAVIT TO AMEND A RECORD (BIRTH, DEATH, FETAL DEATH)
☐VS 24A-PHYSICIAN/CERTIFIER’S AMENDMENT (BIRTH, DEATH, FETAL DEATH)
☐VS 24C-AFFIDAVIT TO AMEND A MARRIAGE RECORD
☐VS 44-COURT REPORT OF ADOPTION
☐VS 85-DELAYED REGISTRATION OF BIRTH
☐VS 105-COURT ORDER DELAYED REGISTRATION OF FETAL DEATH
☐VS 107-SUPPLEMENTAL NAME REPORT-BIRTH
☐VS 108-COURT ORDER DELAYED REGISTRATION OF BIRTH
☐VS 109-COURT ORDER DELAYED REGISTRATION OF DEATH
☐VS 122-COURT ORDER DELAYED CERTIFICATE OF MARRIAGE
☐VS 124-POWER OF ATTORNEY – CALIFORNIA MARRIAGE LICENSE
Mail forms and information to:
Recipient Name
Mailing Address
City, State and Zip code
Phone number
Email address
SUBMIT REQUEST
Click “Submit Request” button, or email the completed form request to:
OVRform@cdph.ca.gov
VS 140 (10/17)