INSTRUCTIONS (PLEASE READ CAREFULLY)
Who can sign the Affidavit for Correction of a Record form?
To correct a BIRTH CERTIFICATE, the person signing this affidavit must be the person of record, his/her parent, guardian, or
legal representative. Medical information (date of birth, time of birth, sex and facility name) must be by the certifier.
To correct a DEATH CERTIFICATE, the person signing this affidavit must be a funeral director from the funeral home on the
certificate, the informant, the certifier or a coroner / medical examiner from the county listed on the death certificate. Medical
information (date of death, time of death, cause of death or any part of cause of death, information concerning communicable
disease or injury) must be by the certifier or a coroner / medical examiner investigating the death.
What do I need to submit with the Affidavit for Correction of a Record?
Other verifiable evidence proving the facts contained in this affidavit. This can include a Supplemental Affidavit. See the
“Correction Evidence Chart”.
A copy of photo identification from the person signing this affidavit.
The payment of $40.00 (includes one certified copy of the corrected certificate). Additional certified copies of the certificate
are $20.00 each. The payment may be made by check, cashier’s check, money order or credit card. Please make your check,
cashier’s check or money order payable to the Office of Vital Records. To pay by credit card, an Authorization for Credit Card
Use form must be completed and submitted.
How do I properly complete the Affidavit for Correction of a Record form?
This is a legal document. Please type or print clearly in blue or black ink only. Illegible completion or any white outs, cross
outs or write overs will be returned. The Affidavit for Correction of a Record must be fully completed to be processed.
The affidavit must be notarized. The person should be at least 18 years of age to make a correction. Signatures of a minor
will be questioned.
Please ensure the sections titled “Statement of Corrections” and “Why Corrections are Necessary” are clear and accurate.
Where do I send the Affidavit for Correction of a Record and supporting documents?
Division of Public and Behavioral Health
Office of Vital Records and Statistics
4150 Technology Way, Suite 104
Carson City, Nevada 89706
Please allow 2 – 4 weeks to process your request. Any questions regarding correcting a certificate should be addressed to the
Office of Vital Records at the above address, or by calling our office at 775-684-4242. Please provide the name, full address of
where the certificate should be mailed to and phone number:
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Name
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Street Address or P.O. Box
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City
State
Zip Code
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Phone Number
