California Sworn Statement for Wildfire Survivors (State of Emergency)
Official state formOther requestsFree downloadLast verified November 10, 2026
Sworn statement for survivors of the Palisades, Eaton, Hurst, Lidia or Woodley Fires who lost certified copies of birth, death or marriage records. The form says they may receive a free certified copy. It is sent with the copy application to the state vital records office.
Who can use this form
- Survivors of the Palisades, Eaton, Hurst, Lidia or Woodley Fires who lost certified copies of birth, death or marriage records
- The applicant must also be a person allowed by state law to receive an authorized copy of the record
What to send with it
- The statement, signed in front of a notary public or state vital records staff
- A completed copy application for the record (VS 111 for birth, VS 112 for death or VS 113-A for marriage)
Where to send it
- Mail to
- See the form for where to file it.
- State fee
- The form says eligible fire survivors receive a free certified copy. The form names the Palisades, Eaton, Hurst, Lidia and Woodley Fires; the office's State of Emergency web page is titled for a different fire.
- Typical processing
- Not provided
- Source
- Official government page