California Court Order Delayed Registration of Death (VS 109)
Official state formDelayed registrationForm VS 109Free downloadLast verified November 10, 2026
Two-part form: an order that a judge of the Superior Court of California signs to establish the fact of a death, and the delayed registration form. The petition is decided in Superior Court. A certified copy of the order is then mailed with the form to the state vital records office.
Who can use this form
- The petitioner who obtained a Superior Court order establishing the fact of the death
- The order must be signed by a judge of the Superior Court
What to send with it
- Completed order signed by the judge, and the completed delayed registration form on page 2
- Certified copy of the order with an original court seal
- Name and mailing address of the applicant
- $26 by check or money order payable to CDPH Vital Records
- Notarized sworn statement, only when asking for authorized copies
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 a $26 registration fee that includes one certified copy, and $26 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