Form BMD-001 "Petition to Establish Fact, Time, and Place of Birth" - California

What Is Form BMD-001?

This is a legal form that was released by the California Superior Court - 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 September 1, 2018;
  • The latest edition provided by the California Superior Court;
  • 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 BMD-001 by clicking the link below or browse more documents and templates provided by the California Superior Court.

ADVERTISEMENT
ADVERTISEMENT

Download Form BMD-001 "Petition to Establish Fact, Time, and Place of Birth" - California

Download PDF

Fill PDF online

Rate (4.4 / 5) 97 votes
BMD-001
ATTORNEY OR PARTY WITHOUT ATTORNEY:
STATE BAR NO.:
FOR COURT USE ONLY
NAME:
FIRM NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE NO.:
FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CASE NUMBER:
IN THE MATTER OF (name):
HEARING DATE AND TIME:
DEPT.:
PETITION TO ESTABLISH FACT, TIME, AND PLACE OF BIRTH
Notice to Petitioners
At or before the court hearing on this petition, you must provide to the court a completed (filled-in) order for the judicial officer to sign.
The order must be prepared on a form issued by the California Department of Public Health Vital Records (CDPH Vital Records), the
Order Establishing Fact of Birth (form VS 108). The top portion of that form is the court order. The bottom portion of that form is the
birth certificate you must submit for filing to CDPH Vital Records with a copy of the signed order certified by the clerk of the court.
Form VS 108 may be obtained from CDPH Vital Records or from a county recorder or health department. Information about the form,
including instructions on how to get it and how to complete and file it with the court and with CDPH Vital Records, is available online
at www.cdph.ca.gov/certlic/birthdeathmar/Pages/CorrectingorAmendingVitalRecords.aspx.
Petitioner (name each):
1.
a.
is beneficially interested in and entitled under section 103450 of the California Health and Safety Code to an order establishing
the fact and the time and place of the birth of the person named in item 2a.
b.
Petitioner's beneficial interest in this matter is as follows:
(1)
I am the person named in item 2a.
(2)
I am related to the person named in item 2a as follows
(specify the relationships of all petitioners to that person):
(3)
I am not related to the person named in item 2a.
(4)
I am interested in this matter for the following reasons (complete unless item 1b(1) is selected):
Continued in Attachment 1b(4).
Petitioner requests the court to establish the fact, time, and place of the birth of the person named in item 2a.
2.
a.
Name:
b.
Father's Name:
Mother's Name:
c.
Time of birth (date and time of day):
a.m.
p.m.
d.
Place of birth: City, town, township, or other (identify “other” if known):
(1)
County:
State (U.S.):
(2)
State or province:
Country:
Page 1 of 2
PETITION TO ESTABLISH FACT, TIME, AND PLACE OF BIRTH
Health and Safety Code,
Form Adopted for Mandatory Use
§§ 103450–103490
Judicial Council of California
www.courts.ca.gov
BMD-001 [Rev. September 1, 2018]
BMD-001
ATTORNEY OR PARTY WITHOUT ATTORNEY:
STATE BAR NO.:
FOR COURT USE ONLY
NAME:
FIRM NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE NO.:
FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CASE NUMBER:
IN THE MATTER OF (name):
HEARING DATE AND TIME:
DEPT.:
PETITION TO ESTABLISH FACT, TIME, AND PLACE OF BIRTH
Notice to Petitioners
At or before the court hearing on this petition, you must provide to the court a completed (filled-in) order for the judicial officer to sign.
The order must be prepared on a form issued by the California Department of Public Health Vital Records (CDPH Vital Records), the
Order Establishing Fact of Birth (form VS 108). The top portion of that form is the court order. The bottom portion of that form is the
birth certificate you must submit for filing to CDPH Vital Records with a copy of the signed order certified by the clerk of the court.
Form VS 108 may be obtained from CDPH Vital Records or from a county recorder or health department. Information about the form,
including instructions on how to get it and how to complete and file it with the court and with CDPH Vital Records, is available online
at www.cdph.ca.gov/certlic/birthdeathmar/Pages/CorrectingorAmendingVitalRecords.aspx.
Petitioner (name each):
1.
a.
is beneficially interested in and entitled under section 103450 of the California Health and Safety Code to an order establishing
the fact and the time and place of the birth of the person named in item 2a.
b.
Petitioner's beneficial interest in this matter is as follows:
(1)
I am the person named in item 2a.
(2)
I am related to the person named in item 2a as follows
(specify the relationships of all petitioners to that person):
(3)
I am not related to the person named in item 2a.
(4)
I am interested in this matter for the following reasons (complete unless item 1b(1) is selected):
Continued in Attachment 1b(4).
Petitioner requests the court to establish the fact, time, and place of the birth of the person named in item 2a.
2.
a.
Name:
b.
Father's Name:
Mother's Name:
c.
Time of birth (date and time of day):
a.m.
p.m.
d.
Place of birth: City, town, township, or other (identify “other” if known):
(1)
County:
State (U.S.):
(2)
State or province:
Country:
Page 1 of 2
PETITION TO ESTABLISH FACT, TIME, AND PLACE OF BIRTH
Health and Safety Code,
Form Adopted for Mandatory Use
§§ 103450–103490
Judicial Council of California
www.courts.ca.gov
BMD-001 [Rev. September 1, 2018]
BMD-001
CASE NUMBER:
IN THE MATTER OF (name):
3.
(Check one of the following):
a.
There is no official record of the fact, time, and place of the birth of the person named in item 2a.
b.
A certified copy of the official record of the birth of the person named in item 2a cannot be obtained for the following
reasons:
Continued in Attachment 3b.
4.
The person named in item 2a now resides at (street address and city):
County:
State:
5.
Petitioner requests that the court make an order determining that the birth of the person named in item 2a did in fact occur at the
time and at the place stated in items 2c and 2d, as shown by the Declaration in Support of Petition to Establish Fact, Time, and
Place of Birth (form BMD-001A) and attachments, filed herewith, and by other proofs adduced at the hearing.
6.
Number of pages attached:
Date:
(SIGNATURE OF ATTORNEY)
(TYPE OR PRINT NAME OF ATTORNEY FOR PETITIONER)
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct, except as to those
matters stated on information and belief, and as to those matters, I am informed and believe them to be true.
Date:
(SIGNATURE OF PETITIONER)
(TYPE OR PRINT NAME OF PETITIONER)
Date:
(SIGNATURE OF PETITIONER)
(TYPE OR PRINT NAME OF PETITIONER)
Date:
(SIGNATURE OF PETITIONER)
(TYPE OR PRINT NAME OF PETITIONER)
BMD-001 [Rev. September 1, 2018]
Page 2 of 2
PETITION TO ESTABLISH FACT, TIME, AND PLACE OF BIRTH
For your protection and privacy, please press the Clear
This Form button after you have printed the form.
Print this form
Save this form
Clear this form
Page of 2