Florida Affidavit of Amendment to a Certificate of Fetal Death (DH 433A)
Official state formCorrections and amendmentsForm DH 433AFree downloadLast verified November 10, 2026
Notarized affidavit to correct or add items on a Florida fetal death certificate. It is sent with application DH 524 to the Correction Unit of the Florida Department of Health vital statistics office in Jacksonville.
Who can use this form
- A parent listed on the fetal death certificate
- Both parents must sign when a father's or parent's name is being added.
- Changes to the medical portion must be confirmed in writing by the attending physician or the medical examiner.
What to send with it
- Notarized affidavit (complete the upper portion only, in black ink)
- Application DH 524
- Check or money order for the fee
Where to send it
- Mail to
- DEPARTMENT OF HEALTH OFFICE OF VITAL STATISTICS ATTN: CORRECTION UNIT P.O. BOX 210 Jacksonville, FL 32231-0042
- State fee
- $20 amendment processing fee, non-refundable, includes one certification of the amended record. The fee is stated on the office's amendments page, not on the affidavit.
- Typical processing
- Not provided
- Form revision
- 04/2016
- Source
- Official government page