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 Supplemental Name Report - Birth

A Supplemental Name Report – 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:

Supporting Documents

Supplemental Name Report – 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-nine dollars ($29) per certified copy.
  • Any time after the first year of birth: There is a twenty-six dollar ($26) processing fee, which includes one certified copy of the amended certificate.  Each additional certified copy is twenty-nine dollars ($29).

Processing Times

Please refer to the Processing Times webpage for current processing times.

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 – Birth VS 107 (PDF) form

Amendment Sworn Statements (English) (PDF) (Spanish) (PDF)

Supplemental Name Report – Birth (PDF) pamphlet

(Español) Informe de Nombre Suplementario - Nacimiento (PDF)

Directory of County Vital Record Offices

Other Amendment Types

General Birth Amendment

Court Order Name Change

Correcting a Sex Field Error

Sex Change/Reassignment


Acknowledgement of Paternity/Parentage

Adjudication of Facts of Parentage

Death/Fetal Death


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