Washington Court Order Legal Name Change Request (DOH 422-126)
Official state formLegal name changeForm DOH 422-126Free downloadLast verified November 10, 2026
Use this form to ask the Washington State Department of Health to change a name on a Washington birth certificate after a court-ordered legal name change. It is mailed to the Center for Health Statistics with a certified copy of the court order.
Who can use this form
- People born in Washington State who have a court order changing their legal name
- The form can also record a court-ordered name change for the mother or parent, or the father or parent, shown on the birth certificate
What to send with it
- The completed form, filled out in ink
- A certified copy of the court order. The court order will not be returned
- Optional: a completed certificate order form, the documents it requires, and a $25 check or money order made out to Dept of Health
- Optional: a certified copy issued less than one year ago, to exchange it at no charge
Where to send it
- Mail to
- Center for Health Statistics PO Box 47814 Olympia, WA 98504-7814
- State fee
- No fee is stated for the name change. $25 per certificate ordered with the request.
- Typical processing
- Two months, per the office's court-ordered name change page
- Form revision
- June 2021
- Source
- Official government page