Supplemental Name Report - Birth
A Supplemental Name Report ā Birth VS 107 (PDF) form is utilized to:
- Add the registrant's first, middle, and/or last name to blank fields on a birth certificate
For additional information please see the informational pamphlet Supplemental Name Report ā Birth.
Supporting Documents
Supplemental Name Report ā Birth is entering a name of the child in the blank spaces on the original birth certificate. No supporting documents are necessary.
Sworn Statement
A notarized Sworn Statement, completed by an authorized person, is required to receive a certified authorized copy of the amended certificate. Please visit the Authorized Copy vs. Informational Copy webpage for a list of authorized persons.
Amendment Fees
- Within the first year from date of birth: There is no fee to amend a certificate. However, to receive a certified copy of the amended certificate there is a fee of twenty-five dollars ($25) per certified copy
- Any time after the first year of birth: There is a twenty-three dollar ($23) processing fee, which includes one certified copy of the amended certificate. Each additional certified copy is twenty-five dollars ($25)
Processing Times
CDPH-VR processing times may occasionally increase as do the volume of requests.
Currently Supplemental Name Report - Birth are processed within six (6) to eight (8) weeks from the date CDPH-VR receives the request.
Helpful Tips
- Complete all documents in black ink
- No erasures, alterations or whiteouts are allowed on the VS 107 form
- This will create a multi-page certificate with the amendment attached
Helpful Links
Supplemental Name Report ā Birth VS 107 (PDF) form
Amendment Sworn Statements (English) (Spanish)
Supplemental Name Report ā Birth pamphlet
Directory of County Vital Record Offices
Other Amendment Types
General Birth Amendment
Court Order Name Change
Correcting a Sex Field Error
Sex Change/Reassignment
Adoption
Acknowledgement of Paternity/Parentage
Adjudication of Facts of Parentage
Death/Fetal Death
Marriage