California Supplemental Name Report for a Birth Record (VS 107)
Official state formCorrections and amendmentsForm VS 107Free downloadLast verified November 10, 2026
Form to add a child's name to blank name fields on a California birth certificate. It is not for correcting or changing a name already on the record. It is mailed to the state vital records office.
Who can use this form
- Two people with knowledge of the facts sign
- At least one signer must be a parent of the child
What to send with it
- Completed VS 107 form in black ink
- Notarized sworn statement, only when asking for an authorized copy
- Fee by check or money order payable to CDPH - Vital Records
Where to send it
- Mail to
- California Department of Public Health Vital Records - Amendments - MS 5105 P.O. Box 997410 Sacramento, CA 95899-7410
- State fee
- The form (Rev. 04/20) prints no fee amount. The office's current pamphlet (01/2026) lists: within 1 year of birth, no fee to register and $31 per certified copy; one year or more, $26 including one certified copy, and $31 for each additional copy.
- Typical processing
- The form does not state a time. The office's processing times page lists an average of 7 to 9 weeks for amendments.
- Form revision
- Rev.04/20
- Source
- Official government page