California Affidavit of Homeless Status for a Fee Exempt Birth Certificate
Official state formOther requestsFree downloadLast verified November 10, 2026
Affidavit used to request one certified copy of a birth record without a fee for a homeless person, child or youth. The form says it can be used with the local registrar, the county recorder where the person was born, or the State Registrar.
Who can use this form
- A homeless person, child or youth
- A person lawfully entitled to request the birth record for a homeless child or youth
- A homeless services provider must also sign, such as a funded agency, a California attorney, a school liaison or social worker, or a police or sheriff liaison
What to send with it
- The affidavit, signed by both the requestor and the homeless services provider
- The regular application for a certified copy of a birth record
- Anything else the birth record application requires
Where to send it
- Mail to
- See the form for where to file it.
- State fee
- No fee. One fee exempt birth record per eligible person, per application.
- Typical processing
- Not provided
- Form revision
- Rev. 10/18
- Source
- Official government page