Fill - Free fillable Affidavit to Amend a Marriage Record (California) PDF form

June 2020 Office of Vital Records Page 1 of 8

Affidavit to Amend a Marriage Record

Center for Health Statistics and Informatics – California Vital Records

Effective October 2020

Introduction

Use the VS 24C - Affidavit to Amend a Marriage Record form to:

 Correct most typographical or spelling errors

 Add information to most blank fields

 Reflect a court order name change on either spouses’ name

 Please see page 8 for a list of frequently asked questions and answers.

 California Vital Records (CDPH-VR) cannot amend confidential marriage

certificates. To amend a confidential marriage certificate, please refer to the

County Clerk’s office in the county where the marriage license was issued.

 To establish a court order delayed registration of marriage, please refer to the

Court Order Delayed Certificate of Marriage Pamphlet.

What to Submit and Mailing Address

To request an amendment, please submit the following:

 Properly Completed VS 24C Form (See Form Guidelines beginning on page 3.)

 Notarized Sworn Statement (Only if requesting authorized copy. See page 6.)

 Appropriate Fee(s) (See top of page 7.)

 Supporting Documentation (See bottom of page 7.)

 Photocopy of Current Marriage Certificate (With Local Registration Number listed)

Mail your packet to the address below:

California Department of Public Health

Vital Records – Amendments – M.S. 5105

P.O. Box 997410

Sacramento, CA 95899-7410

 Amended certificates are returned via standard mail and do not contain a

tracking number.

 You may provide a prepaid self-addressed envelope with your request for

CDPH-VR to use and mail the amended certificate back to you. (Not Required)

VS 24C - Affidavit to Amend a Marriage Record Checklist

To assist in the registration of your amendment, please submit the following:

Properly Completed VS 24C Form

The form is completed in black ink and does not contain alterations or writing in the margins.

Part I matches the current marriage certificate, (even if the information is incorrect).

Part II, column 5 lists the current marriage certificate’s item number that needs correction.

Part II, column 6 lists the incorrect information as it appears on the current marriage certificate.

Part II, column 7 lists the correct information as it should appear on the amended certificate.

Part II, item 8 lists a reason for correction.

REQUIRED: If correcting a county clerk error, reason for correction states: "To correct county

clerk error."

Fields 9A through 10D are completely filled out in black ink with proper signatures.

I am correcting the date of marriage, place of marriage, or officiant information.

REQUIRED: One of the signatures is the marriage officiant.

I am correcting a county clerk error in the new name field(s).

REQUIRED: One of the signatures is the county clerk.

I am changing my name in the new name field after a court order name change or name

change obtained during the naturalization process.

REQUIRED: Item 8 states: "To change the new name after a court order name change, case

number ###." Or "To change the new name after the naturalization process."

Supporting Documentation

I am correcting errors in the personal data listed for one of the parties to the marriage.

REQUIRED: I included a photocopy of the person's birth certificate, translated to English if necessary.

I changed my name through the courts and am changing my name in the new name field.

REQUIRED: I have included a certified copy of the court order name change or a photocopy of

the naturalization certificate and photocopy of the Petition for Name Change form from the

Department of Homeland Security.

I am correcting an error in the parent information listed for one of the parties to the marriage.

REQUIRED: I included a photocopy of the person's birth certificate, translated to English if necessary.

Payment

I am submitting the amendment WITHIN ONE (1) YEAR of date of marriage:

There is no fee to register the amendment and I do not want a copy of the amended certificate.

I would like a copy of the amended certificate, and I have enclosed a check/money order

(payable to CDPH Vital Records) in the amount of fifteen dollars ($15) per copy.

I am submitting the amendment ONE (1) YEAR OR MORE AFTER the date of marriage:

I have enclosed a check/money order (payable to CDPH Vital Records) in the amount of

twenty-three dollars ($23) for the registration of the amendment, which includes one copy of

the amended certificate.

I would like additional copies of the amended certificate, and I have enclosed a check/money

order (payable to CDPH Vital Records) in the amount of fifteen ($15) per additional copy

requested.

Notarized Sworn Statement

I would like an authorized copy of the amended certificate, and I have enclosed a notarized sworn

statement.

Photocopy of Marriage C

ertificate With Local Registration Number

June 2020 For more information visit our website at www.cdph.ca.gov.

Page 2 of 8

Affidavit to Amend a Marriage Record

June 2020 Office of Vital Records Page 3 of 8

Form Guidelines

To prevent processing delays, please adhere to the following guidelines on

how to complete the Affidavit to Amend a Marriage Record (VS 24C) form.

General Information

The VS 24C form must:

 Be completed legibly in black ink using the 26 alphabetical characters of the

English language.

 Not contain any write-overs, whiteouts, alterations, drawings, symbols,

accents, or other marks to indicate pronunciation or to distinguish letters in

some way, such as è, ñ, ē, or ç.

Part I

PART I must match the current certificate. This means:

 It should show any incorrect information as it appears on the current record.

 If any of the information in Part I was previously amended, the changes must

be reflected in Part I of the VS 24C form.

Part II (Column 5)

PART II Column 5 must list the certificate item number that needs correction.

NOTE: This is the number located on the top left corner of the box being corrected

on the marriage certificate.

Affidavit to Amend a Marriage Record

June 2020 Office of Vital Records Page 4 of 8

Form Guidelines (Continued)

Part II (Column 6)

Part II Column 6 must list the incorrect information as it appears on the current

marriage certificate.

Part II (Column 7)

Part II Column 7 must list the correct information as it should appear on the

marriage certificate.

If either spouse obtained a court order name change, and:

 If the certificate does not contain a new name section, the court ordered name

change may be added as an AKA (also known as) to the top of the certificate.

 If there is a “new name” section on the certificate, the court ordered name

change may be changed in the new name section (not added as an AKA).

Reason for Correction (Box 8)

Box 8 must contain a reason for correction. Please see requirements below when

correcting a county or deputy clerk error or adding a court ordered name change

for either spouse:

 If correcting a county or deputy clerk’s clerical error, the reason for

correction must state “To correct clerical error.”

 If adding either spouses’ AKA (also known as) after a court order name

change, include the court case number in reason for correction.

 If changing the new name section of the certificate after a court order name

change, include the court case number in reason for correction.

Affidavit to Amend a Marriage Record

June 2020 Office of Vital Records Page 5 of 8

Form Guidelines (Continued)

Affidavit and Signatures

Two people with knowledge of the facts must sign and complete the Affidavit

and Signatures section. Please see requirements below when correcting a county

or deputy clerk’s clerical error, or an error made by the person who solemnized

the marriage:

 If correcting the date of marriage, place of marriage, or data from the person

who solemnized the wedding, one of the signors should be the person who

solemnized the marriage.

 If correcting a county or deputy clerk’s clerical error in the new name section,

the two signers required are:

o One of the spouses

o A county or deputy clerk

The new name section can only be changed to:

 Correct a county or deputy clerk’s clerical error

 Reflect a spouse’s court order name change

End of Form Guidelines section.

Affidavit to Amend a Marriage Record

June 2020 Office of Vital Records Page 6 of 8

Notarized Sworn Statement

An authorized person must submit a notarized sworn statement to receive a certified

authorized copy of the amended certificate. Please see list of authorized persons below:

 Registrant (Name on Certificate)

 Grandparent/Grandchild of

Registrant

 Authorized by Court Order (Include

copy of court order.)

 Law Enforcement/Govt. Agency

(Conducting Official Business)

 Parent/Legal Guardian of Registrant

(Legal guardian must provide

documentation.)

 Child of Registrant

 Spouse/Registered Domestic Partner of

Registrant

 Attorney Representing Registrant or

Registrant’s Estate

 Power of attorney/Executor of the

registrant’s Estate (Include a copy of the

power of attorney or supporting

documentation identifying you as executor.)

 Sibling of Registrant

The notarized sworn statement must:

 Include a penalty of perjury statement

 Identify the applicant’s relationship to the registrant

 Be signed in the presence of a notary public

 Contain the notary’s official seal. (NOTE: A sworn statement notarized by a foreign

notary must have an apostille attached. Foreign notarizations obtained at a United

States Embassy or Consulate do not require an apostille.)

Please see sample sworn statement below. (The notary completes the Certificate of

Acknowledgment section after the applicant’s signature is witnessed.)

Affidavit to Amend a Marriage Record

June 2020 Office of Vital Records Page 7 of 8

Appropriate Fee(s)

If Amending the Marriage Record Within One (1) Year of Date of Marriage:

 There is no fee to register the amendment, however a certified copy of the certificate

will not be issued.

 The fee for each certified copy of the amended record is fifteen dollars ($15). There is

no fee to register the amendment, but you must pay a fee to receive a certified copy of

the amended record.

 Checks or Money Orders must be made payable to CDPH Vital Records.

If Amending the Marriage Record One (1) Year or More From Date of Marriage:

 There is a twenty-three dollar ($23) registration fee, which includes one (1) certified

copy of the amended certificate.

 Additional certified copies are fifteen dollars ($15) each.

 Checks or Money Orders must be made payable to CDPH Vital Records.

Supporting Documentation

It is preferred that you submit documentation supporting the amendment requested. Please

submit any applicable documents listed below:

 If either spouse is adding a court ordered name change to the certificate, please

submit a certified copy of the court order name change, which contains a(n):

o Original court seal. (This authenticating court seal cannot be a photocopy.)

o Signature or stamp of the judge’s signature.

o Signature/stamp of the court clerk’s signature

 If correcting a typographical error on either spouses’ statistical information,

including their name, date of birth, place of birth, or parental information, please

submit a photocopy of the person’s birth certificate.

Affidavit to Amend a Marriage Record

June 2020 Office of Vital Records Page 8 of 8

Frequently Asked Questions

Q: Where can I find forms and pamphlets?

A: Please see links below.

 Affidavit to Amend a Marriage Record - VS 24C form

(https://www.cdph.ca.gov/CDPH%20Document%20Library/ControlledForms/VS

24c.pdf)

 Sworn Statement Webpage

(https://www.cdph.ca.gov/Programs/CHSI/Pages/Sworn-Statement.aspx)

 Court Order Delayed Certificate of Marriage – Informational Pamphlet

(https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/ADA_

COD%20Marriage%20(01-18).pdf)

 CDPH Vital Records Website – All other informational pamphlets and forms

(https://www.cdph.ca.gov/Programs/CHSI/Pages/Correcting-or-Amending-Vital-

Records.aspx)

Q: What is the current processing time?

A: Current processing times are listed on the CDPH-VR website.

(https://www.cdph.ca.gov/Programs/CHSI/Pages/Vital-Records-Processing-Times.aspx)

Q: Once the amendment is registered, what happens to the marriage certificate?

A: Amendments become part of the original record, resulting in a multi-page certificate.

You must keep the certificate with all amendments attached for the marriage

certificate to be valid.

Q: Will my supporting documents be returned?

A: Supporting documents, including sworn statements and courts orders,

are

not returned

ame

ment is registered. Please keep copies of all documents submitted.

Q: What is a confidential marriage certificate?

Confidential marriage certificates are a type of marriage license that are clearly titled

CONFIDENTIAL and are maintained by the county of issuance. California Vital Records

(CDPH-VR)

cannot amend confidential marriage certificates. Please refer to the County

Clerk’s office in the

county where the marriage license was issued to request

amendments to confidential marriage

certificates.

Q: What if I still have questions?

A: Please contact ou

r Customer Service Unit by email at AmendVR@cdph.ca.gov

telephone at (916) 445-2684.

State of California – Health and Human Services Agency California Department of Public Health

VS 20 (1/20)

Page 1 of 2

SWORN STATEMENT INSTRUCTIONS

• Only one sworn statement is required for multiple records.

• Sworn statements are not required for informational copy requests.

• Authorized individuals must complete the top portion of the sworn statement by signing and

identifying their relationship to person listed on certificate.

• Sworn statements must be notarized for authorized copy requests. Law enforcement,

governmental agencies, and funeral establishments (death records only) are exempt from the

notary requirement, but must complete the top portion of the sworn statement page.

• A sworn statement notarized by a foreign notary must have an apostille attached. Foreign

notarizations obtained by an Ambassador, Minister, Consul, Vice Consul or Consular Agent of the

United States, or from a Judge of Court of record having a seal in a foreign county do not require

an apostille.

RELATIONSHIP TO REGISTRANT

List of Authorized Persons:

• The registrant or a parent, legal guardian, child, grandparent, grandchild, sibling, spouse, or

domestic partner of the registrant.

• A party entitled to receive the record as a result of court order or an attorney or licensed adoption

agency seeking the birth record in order to comply with the requirements of Section 3140 or

7603 of the Family Code. (Please include a copy of the court order.)

• A member of a law enforcement agency or a representative of another governmental agency, as

provided by law, who is conducting official business. (Companies representing a government

agency must provide authorization from the government agency.)

• Any person or agency empowered by statute or appointed by a court to act on behalf of the

registrant or the registrant’s estate (Include a copy of the power of attorney or documentation

identifying you as executor.)

• An attorney representing the registrant or the registrant’s estate.

• Any agent or employee of a funeral establishment who acts within the course and scope of

employment and on behalf of persons specified in HSC § 7100 (a) (1)-(8).

• Surviving next of kin (As specified in HSC § 7100).

State of California – Health and Human Services Agency California Department of Public Health

VS 20 (1/20)

Page 2 of 2

SWORN STATEMENT

(Applicant’s Printed Name)

, declare under penalty of perjury under the laws of the

State of California, that I am an authorized person, as defined in California Health and Safety Code Section 103526

(c), and am eligible to receive a certified copy of the birth, death, or marriage certificate of the following

individual(s):

, .

Regis

trant

(Name of person whose certificate

you are requesting)

Applicant's Relationship to Registrant

(Must be an authorized person)

(The remaining information must be completed in the presence of a Notary Public or CDPH Vital Records staff.)

Subscribed to this

(Day)

day of

(Month)

, 20 , at

(City) (State)

(Applicant’s Signature)

CERTIFICATE OF ACKNOWLEDGMENT

A notary public or other officer completing this certificate verifies only the identity of the individual

who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or

validity of that document.

State of

County of

On before me,

(Insert name and title of the officer)

personally appeared

who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed

to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their

authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity

upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under

the laws of the State of California that the foregoing paragraph is true and correct

WITNESS my hand and official seal.

(SEAL)

(SIGNATURE OF NOTARY PUBLIC)

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