VITAL RECORDS

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:

Supplemental Name Report – Birth (PDF)
(Español) Informe de Nombre Suplementario - Nacimiento (PDF)

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).