Fillable Printable Birth Certificate Change or Correct Form - Colorado
Fillable Printable Birth Certificate Change or Correct Form - Colorado
Birth Certificate Change or Correct Form - Colorado
REGISTRANT’S INFORMATION CURRENTLY LISTED ON THE BIRTH CERTIFICATE
1. First Name
1a. Middle Name
1b. Last Name(s)
1c. Suffix
1d.
Date of Birth (Month/Day/Year)
2. Mothers name prior to first marriage (maiden)
3. Father’s Name
INCORRECT INFORMATION
CORRECT INFORMATION
4. First Name Middle Name Last Name(s)
4a. First Name Middle Name Last Name(s)
5
.
Other
5a. Other
6
.
Other
6a. Other
7
.
Other
7a. Other
The penalties for obtaining a record under false pretenses include a fine of not more than $1,000 or imprisonment in the county jail for not more than one year or both such fine and
imprisonment (CRS 25-2-118). By signing below, I have read and understood that there are penalties for obtaining a record under false pretenses.
The information above is true to the best of my knowledge and I/we request that the birth certificate be changed accordingly.
8. Signature of requestor
8a. Date 8b. Your relationship to the registrant (Check Box
)
Mother Father Self Legal Representative (must provide proof)
9. Signature of requestor
9a. Date 9b. Your relationship to the registrant (Check Box
)
Mother Father Self Legal Representative (must provide proof)
10. Address
10a. City 10b. State
10c. Zip
11. Contact phone number
12. Email (print clearly)
***EXCHANGE POLICY ►
Effective 7/1/2011 previously issued certified copies of the birth certificate may be exchanged at any time after a correction or change
has been made to a birth certificate for $10.00 each. You must return the Birth Certificate(s) to utilize this service or present it to us
before any transaction is requested.
PAYMENTS ACCEPTED ►
We accept Checks (no temporary), Money Orders (Payable to Vital Records) and Credit Cards.
Not responsible for cash sent through the mail
*CREDIT CARD ORDERS (check box
)►
Visa
MasterCard Discover
Convenience charge will apply (see fee schedule above)
Cardholder Name
Cardholder Signature
Credit Card Number
Expiration Date
Total Charges ($)
ENGLISH
CONTACT INFORMATION
NAME: Jake J. Salazar
PHONE: 303-692-2226
EMAIL:
FAX: 1-877-785-1434 **excludes court orders
ESPANOL
INFORMACIÓN DE CONTACTO
NOMBRE: Alicia Hernandez
TELEFONO: 303-692-2230
CORREO ELECTRONICO:
FAX: 1-877-785-1434 **excludes court orders
** All court orders submitted to make a change to a Birth Certificate must be certified and bears the original seal of the court.
MAILING & PHYSICAL ADDRESS ►
Vital Records, Modification Unit, 4300 Cherry Creek Drive South, Denver, Colorado 80246-1530
WEBSITE ►
(access forms, order online, other information)
PROCESSING TIME ► Upon receipt of your request please allow up to 30 days for your order to be processed **** See expedite fee above
CHECKLIST
►
TO AVOID DELAY ENCLOSE ALL NECESSARY DOCUMENTATION. PLEASE SEND THE FOLLOWING:
1. Form to Correct or Change a Birth Certificate 2. Documentary Evidence 3. Processing and Certificate Order Fees.
4. ID, Effective 11-01-2003, return your request with a copy of your driver’s license, state ID, passport or other acceptable ID.
25-2-115. Alteration of reports and certificates - amended reports and certificates.(5) When an applicant does not submit the minimum documentation required in the regulations for amending a vital statistics record or when the
state registrar has reasonable cause to question the validity or adequacy of the applicant's sworn statements or documentary evidence, and if the deficiencies are not corrected, the state registrar shall not amend the vital statistics
record and shall advise the applicant of the reason for this action and shall further advise the applicant of the right of appeal to a court of competent jurisdiction.
Keep as a permanent record
SERVICES AND FEES
(Fees are non-refundable)
Quantity (#)
Fees ($)
Total ($)
Correct or Change a Birth Certificate - (this fee does not include birth certificate)
20.00
=
1
st
certified copy of the Birth Certificate - (***if applicable, see exchange policy below)
x 17.75
=
Additional copies of the same certificate ordered at the same time or exchanges (*** See exchange policy)
x 10.00
=
Heirloom Certificate - To see image of Heirloom visit our website
x 35.00
=
*Credit Card Convenience Charge (walk-ins excluded) (waived for expedited service)
10.00
=
****Expedite Fee (processed within 15 days upon receipt of your request)
20.00
=
Total Number of Birth Certificates requested ►
Grand Total ►
FORM TO CORRECT OR CHANGE A COLORADO BIRTH CERTIFICATE
Complete this form in ink; Crossouts and/or white are not acceptable; This form cannot be used to add the father to the birth certificate
“See first page or front of sheet if form is back to back”
INSTRUCTIONS FOR CORRECTING OR CHANGING A COLORADO BIRTH CERTIFICATE
1. WHO MAY APPLY TO CORRECT OR CHANGE A BIRTH CERTIFICATE (See #2 below if child is under the age of one)
REGISTRANT’S AGE ►
UNDER 18 - application may be made by one or both parents, a legal guardian, or a legal representative (must show proof)
OVER 18 - application must be made by the registrant or his/her legal representative (must show proof)
Unless otherwise provided in Colorado Regulations or in Statute, all corrections or changes to birth certificates shall be supported by the following:
A written request or by using the Form To Correct Or Change A Colorado Birth Certificate setting forth:
a. Information to identify the certificate (boxes 1-3)
b. The incorrect information as it is listed on the certificate (boxes 4-7)
c. The correct information as it should be listed (boxes 4a-7a)
Note ► When presenting documentary evidence for the correction or change to a birth certificate we only need one eligible party to sign the correction or change form.
2. REGISTRANT’S GIVEN NAMES ON A BIRTH CERTIFICATE WITHIN THE FIRST YEAR OF BIRTH (AGE 0-1)
Note ► The request for the correction or change must be signed in the order listed below (no documentation is needed)
a. Both parents (if only one parent is listed on the birth certificate, only that parent needs to sign the Form to Correct or Change a Colorado Birth Certificate)
b. Mother in the case of a child born out of wedlock (Unless a father is listed on the birth certificate)
c. Father in the case of the death or incapacity of the mother (must show proof of death or Incapacity)
d. Mother in the case of the death or incapacity of the father (must show proof of death or Incapacity)
e. Guardian or agency having legal custody of the registrant (must show proof of legal representation)
3. FOR ALL OTHER AMENDMENTS WE NEED THE FOLLOWING
SUPPORTING DOCUMENTS REQUIREMENTS
a. One or more documents which support the alleged facts and were established at least five years prior to the date of application for the correction or change or within
seven years of the date of birth of the registrant.
b. The document must contain the date of birth or the age of the subject person.
c. After one year from the date of birth; a legal change of name order must be submitted from a court of competent jurisdiction to change the given or last name(s). If
applicable, the provisions of section 9.2 acknowledgement of paternity (add biological father) may be followed to correct or change a last name on the birth
certificate. (The last name can only be changed to that of the father)
4. SUGGESTED SUPPORTING DOCUMENTS:
a. Any document that appears to be altered will not be accepted
b. Original document(s) sent to us will be returned to you
•
Baptismal, Dedication, Blessing or Christening record
•
Military Records e.g., Military Discharge - Form DD214, ID card
•
Employment record (I-9) (Paycheck stubs are unacceptable)
•
Voter registration record. (Obtain from your election commission)
•
Hospital Souvenir Birth Certificate (if applicable)
•
Mother or Father’s birth/death certificate (if applicable)
•
Passport (Foreign or Domestic)
•
Motor Vehicle Record (Obtain from the Driver’s License Office of issuance)
•
Permanent resident alien card or document
•
Immunization Record(s) (Must have medical office/clinic listed on the record)
•
Sibling’s birth certificate
•
Your child’s birth certificate
•
Marriage License application (Marriage Li
censes from some states are acceptable)
•
U.S. Census Record (Obtain from Bureau of Census, P.O. Box 1545, Jeffersonville, IN 47131)
•
Court ordered legal name change (The court order must be certified and bear the seal of the court)
•
Medical, Hospital or Physician’s records. (Must have Medical Office/Clinic listed on the record)
•
Certified school census, transcript, or enrollment record (Report cards & diplomas are unacceptable)
•
Social Security Statement in conjunction with subject persons Social Security Card and Marriage License (if applicable)
•
Naturalization Certificate and in some cases in conjunction with the court ordered legal name change (1-800-375-5283)
•
Insurance policy – (Health, Life, or Auto) - (the application page) - showing name, and date of birth (must show it was accepted by the agency)
ITEM TO BE CORRECTED OR CHANGED
AGE
(years)
DOCUMENTATION OR SUPPORT REQUIRED
Registrant’s given name (first, middle and last) Under 1 See #2 above and in some cases a court order may be necessary
**CRS 25-2-115 (5)
Registrant’s given name (first, middle and last) Over 1 Certified copy of a court ordered Legal Name Change
Registrant’s given name (first and/or middle) Over 1 Certified copy of a court ordered Legal Name Change
Registrant’s given name (last name) Over 1
Certified copy of a court ordered Legal Name Change OR Section 9.2 Acknowledgment of
Paternity (if applicable) (The last name can only be changed to that of the father)
Registrant’s suffix, hyphen, spaces , or apostrophe’s Over 1 Certified copy of a court ordered Legal Name Change
Registrant’s date of birth (month and day) All ages See above #3 & #4 ”The year of birth will have to be changed via a court order”
Registrant’s gender, time of birth, or date of birth Under 2 Contact the Medical Records Department where the child was born
Registrant’s gender (except via surgical procedure) All ages
Medical or hospital record (the document does not need to be 5 years old) or a statement
from a physician.
Registrant’s spelling of their last name to conform to the spelling
of the parents last name
Over 1
See above #3 & #4 “Correct the spelling of the parents last name then you can conform the
registrant’s last name to the spelling of the parents”
Registrant’s spelling of their last name All ages See above #3 & #4 and in some cases a court order may be necessary
**CRS 25-2-115 (5)
Parent’s information (Name, date of birth, place of birth) All ages See above #3 & #4 and in some cases a court order may be necessary
**CRS 25-2-115 (5)
Date of birth on a delayed birth record (court ordered) All ages Court order substantiating the changes to be made on the Birth Certificate
Date of birth on a delayed birth record (not court ordered) All ages Documentary evidence must be dated prior to the filing of the Delayed Birth Certificate.
All other information on a delayed birth record (court ordered) All ages Court order substantiating the changes to be made on the Birth Certificate
All other information on a delayed birth record (not court ordered) All ages See above #3 & #4 dated after the filing of the Delayed Birth Certificate
•
Social Security Numident (
To purchase a Numident, write to SSA, OEO FOIA Workgroup, 300 N. Green St., Baltimore MD 21290-3022 – Fee is $16.00 or call 1-800-772-1213)
•
Social Security Numident (
To purchase a Numident, write to SSA, OEO FOIA Workgroup, 300 N. Green St., Baltimore MD 21290-3022 – Fee is $16.00 or call 1-800-772-1213)
•
Driver's License or State issued ID (USA and Terratories only)
