New York Parents' Affidavit for Conforming Change of Child's Name on Birth Certificate (DOH-1862)
Official state formLegal name changeForm DOH-1862Free downloadLast verified November 10, 2026
Notarized affidavits both parents sign so a child's name can be changed on the amended birth certificate that the Department of Health prepares after a Family Court determination of parentage. They go to the Vital Records Amendment Unit in Albany.
Who can use this form
- The father who has been adjudicated by a court to be the child's father, and the child's biological mother.
- Each parent signs their part in front of a notary public.
- Both parents must agree on the child's name. If they do not, the name stays as it is on the original birth certificate and a court order is needed to change it.
- The cover letter notes that New York State Family Court does not have jurisdiction over name changes.
What to send with it
- The form with the father's affidavit and the mother's affidavit completed, signed and notarized.
- The child's name as it should be recorded on the amended birth certificate, written the same way by both parents.
- The office's birth corrections instructions also list a certified copy of the marriage certificate with this form.
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
- 2/2002 (cover letter AMD-034, 07/2004)
- Source
- Official government page