New York Mother's and Husband's Affidavits to Add Husband's Name to Birth Certificate (DOH-4092)
Official state formCorrections and amendmentsForm DOH-4092Free downloadLast verified November 10, 2026
Two notarized affidavits used to enter the father's name on a child's birth certificate when the mother and father were married when the child was born, and to change the child's name if both agree. They go to the Vital Records Amendment Unit in Albany.
Who can use this form
- The mother and her husband, who were married to each other when the child was born and have never been divorced.
- Each parent completes and signs their own affidavit in front of a notary public.
- Both parents must agree on the child's name. Otherwise the name stays as it is on the original birth certificate and a court order is needed to change it.
What to send with it
- The Mother's Affidavit (DOH-4092M), signed and notarized.
- The Husband's Affidavit (DOH-4092H), signed and notarized.
- A copy of the parents' marriage license, as the cover letter says. The office's birth corrections instructions ask for a certified copy of the marriage certificate.
Where to send it
- Mail to
- New York State Department of Health Vital Records Section/Amendment Unit P. O. Box 2602 Albany, New York 12220-2602
- State fee
- The form prints no fee. The office's birth corrections instructions (August 2020) say there is no fee for a correction or an amendment, a certified copy of a corrected record costs $30, and one amended birth certificate is issued free of charge after an amendment.
- Typical processing
- Not provided
- Form revision
- Affidavits DOH-4092M and DOH-4092H: 11/2001; cover letter DOH-4092L: 04/2004
- Source
- Official government page