Pennsylvania Request to Modify Parentage on a Birth Record (HD002109)
Official state formParentage and paternityForm HD002109Free downloadLast verified November 10, 2026
Asks the Pennsylvania Department of Health to add or remove a parent on a birth record because of a marriage, an Acknowledgment of Paternity or a court order. It is not for adoption. Mail it to the Birth Registry in Harrisburg.
Who can use this form
- A parent of a child younger than 18
- The person named on the record, if 18 or older
- A person asking on behalf of the child or parent, who must state the reason and relationship
What to send with it
- Completed form, with Part 6 signed by both parents, and by the child if the child is the applicant
- Photocopy of a valid government-issued photo ID, or two current documents that show your name and address
- Government-issued marriage certificate, or the date the Acknowledgment of Paternity was sent to the Department of Human Services, or a certified court order determining parentage
- Notarized signatures when a parent is added because of marriage
- To remove a parent: a certified court order or an approved cancellation of an Acknowledgment of Paternity
- Check or money order payable to "VITAL RECORDS" if you ask for an updated certificate
Where to send it
- Mail to
- Pa. Department of Health Bureau of Health Statistics and Registries ATTN: Birth Registry 555 Walnut St., 6th Floor Harrisburg, PA 17101-1934
- State fee
- No amendment fee is stated. $20.00 for each updated birth certificate, if one is requested. The certificate fee is waived when the incorrect certificate of an infant under 6 months, or one received in the last 45 days, is returned, and for members of the U.S. armed forces.
- Typical processing
- Approximately 20 weeks
- Form revision
- REV 04/21
- Source
- Official government page