Application for Birth Certificate - Sutter County, California

This California-specific printable "Application for Birth Certificate" is a part of the legal paperwork issued by the Sutter County Clerk Recorder.

Download the up-to-date PDF by clicking the link below and mail it as per the guidelines provided by the department.

ADVERTISEMENT
Sutter County Clerk-Recorder
Donna M. Johnston, County Clerk-Recorder-Registrar of Voters
433 Second Street
Yuba City, CA 95991
Phone: (530) 822-7134
Fax: (530) 822-7214
APPLICATION FOR BIRTH CERTIFICATE
California Health & Safety Code, Section 103526, permits only authorized persons as defined below to receive Authorized Certified
Copies of Vital Records. Those who are not authorized by law to receive an Authorized Certified Copy will receive an Informational
Certified Copy marked “INFORMATIONAL, NOT VALID DOCUMENT TO ESTABLISH IDENTITY.”
Authorized Certified Copy or
Informational Certified Copy
Please indicate whether you would like an:
Birth Certificate Information:
Last Name: _______________________ First Name: _____________________ Middle: _____________
Date of Birth (Month-Day-Year): ______-_______-________ Number of Copies ($25 each): _________
Applicant Information (Person Making Request):
Name of Applicant: __________________________
Telephone Number ______-_______-_________
Mailing Address: _____________________________ City: ___________ State: ____ Zip Code: ______
Signature of Applicant: ______________________________________________
Date: ___________
Who are you - Relationship of Applicant to Registrant on Certificate (Mark One):
Registrant
Parent/Legal Guardian
Grandparent/Grandchild
Child
(Name on Certificate)
Law Enforcement/Govt Agency
Licensed Adoption Agency
Spouse/Domestic Partner
Sibling
Agent/Employee Funeral Establish.
Attorney of Record
Authorized by Court Order
I, ___________________________________ swear (or affirm) under penalty of perjury under the laws of the State of
California, that I am an authorized person, as defined in California Health & Safety Code Section 103526 (c), and eligible
to receive an Authorized Certified copy of the vital record identified on this application form.
Sworn this ____ day of ____________________, 20____, at _______________________________________________
City and State
Signature:_____________________________________
For Requests By Mail For Authorized Certified Copy-The following must be completed by a Notary Public.
Notary Acknowledgement
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document, to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of _____________________) ss.
County of ___________________)
On ___________ before me, __________________________, a Notary Public, personally appeared ___________________________
who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and
acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the
person, or the entity upon behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature of Notary: _________________________________
(seal)
Sutter County Clerk-Recorder
Donna M. Johnston, County Clerk-Recorder-Registrar of Voters
433 Second Street
Yuba City, CA 95991
Phone: (530) 822-7134
Fax: (530) 822-7214
APPLICATION FOR BIRTH CERTIFICATE
California Health & Safety Code, Section 103526, permits only authorized persons as defined below to receive Authorized Certified
Copies of Vital Records. Those who are not authorized by law to receive an Authorized Certified Copy will receive an Informational
Certified Copy marked “INFORMATIONAL, NOT VALID DOCUMENT TO ESTABLISH IDENTITY.”
Authorized Certified Copy or
Informational Certified Copy
Please indicate whether you would like an:
Birth Certificate Information:
Last Name: _______________________ First Name: _____________________ Middle: _____________
Date of Birth (Month-Day-Year): ______-_______-________ Number of Copies ($25 each): _________
Applicant Information (Person Making Request):
Name of Applicant: __________________________
Telephone Number ______-_______-_________
Mailing Address: _____________________________ City: ___________ State: ____ Zip Code: ______
Signature of Applicant: ______________________________________________
Date: ___________
Who are you - Relationship of Applicant to Registrant on Certificate (Mark One):
Registrant
Parent/Legal Guardian
Grandparent/Grandchild
Child
(Name on Certificate)
Law Enforcement/Govt Agency
Licensed Adoption Agency
Spouse/Domestic Partner
Sibling
Agent/Employee Funeral Establish.
Attorney of Record
Authorized by Court Order
I, ___________________________________ swear (or affirm) under penalty of perjury under the laws of the State of
California, that I am an authorized person, as defined in California Health & Safety Code Section 103526 (c), and eligible
to receive an Authorized Certified copy of the vital record identified on this application form.
Sworn this ____ day of ____________________, 20____, at _______________________________________________
City and State
Signature:_____________________________________
For Requests By Mail For Authorized Certified Copy-The following must be completed by a Notary Public.
Notary Acknowledgement
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document, to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of _____________________) ss.
County of ___________________)
On ___________ before me, __________________________, a Notary Public, personally appeared ___________________________
who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and
acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the
person, or the entity upon behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature of Notary: _________________________________
(seal)
COUNTY OF SUTTER
INSTRUCTIONS FOR REQUESTING A BIRTH RECORD IN PERSON
1) Come to the Sutter County Clerk & Recorder Office located at 433 Second
Street, Yuba City, California.
2) Complete the Application form for a Birth Certificate Request also available in the
office.
3) Public counter is open and available for processing between 8:00 am to 5:00 pm,
Monday through Friday. Most applications can be processed upon submission.
Payments must be in the form of cash, check or money order. Debit and credit
card services are available at an additional $2.50 convenience fee.
INSTRUCTIONS FOR REQUESTING A BIRTH RECORD BY MAIL
1) Complete the Application form for a Birth Certificate Request.
2) If requesting an Authorized Certified Copy, the Notary Acknowledgement must
be completed by a Notary Public. If an Informational Certified Copy is being
requested, the Notary Acknowledgement does not have to be completed.
Informational copies cannot be used to obtain passports or used with DMV.
3) Birth Certificates are $25 per copy, enclose a check or money order payable to
“Sutter County Clerk Recorder,” for the appropriate amount.
4) Please include a self-addressed stamped envelope for accurate service. Allow at
least 5 working days to receive your Certified Copy in the mail.
5) Mail the application and payment to the following address:
Sutter County Clerk-Recorder
433 Second Street
Yuba City, CA 95991
For Expedited Service:
Mail the completed application and payment in an Overnight Express envelope
and include a prepaid Overnight Express envelope inside to be returned to you.

Download Application for Birth Certificate - Sutter County, California

1501 times
Rate
4.6(4.6 / 5) 90 votes
ADVERTISEMENT
Page of 2