Fill - Free fillable Filing Fee: The filing fee is $270. About (Family Law Self Help Center) PDF form

Many family law matters involve complex and valuable legal rights which cannot adequately be protected without the assistance

of an attorney. The information provided is basic, general information that does not fit all situations. It is the duty of each self-

represented individual to know what rules of court and law apply. For more information on the law, these forms, and free classes,

visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road.

Filing Fee: The filing fee is $270.

About This Packet: This packet is for parents whose names are incorrect on a child’s birth

certificate due to a clerical error (a misspelling, last names that are not in the right order,

etc.). These forms do not allow you to change the child’s name, or to change the parent’s

name to someone else’s name.

Use black ink and write clearly.

 Family Court Cover Sheet

This form provides basic information about the parties so the Clerk can open your case.

 Petition to Correct Birth Certificate

This form tells the Court what is wrong on the birth certificate. If a parent’s name is

wrong, clearly write in section 4 the incorrect name as it appears on the birth certificate

and the correct name that should appear. Both parents should sign this form, or explain

in section 6 why one parent is not signing.

 Copy of Birth Certificate

Attach a copy of the child’s birth certificate to this form.

 Request for Summary Disposition & Declaration in Support

This form asks the judge to grant the correction without you having to appear at a hearing.

If a parent’s name is wrong on the birth certificate, clearly write the corrected name that

should appear. Both parents should sign this form.

 Order for Correction of Birth Certificate

The judge signs this if the correction is approved. Complete everything on the form

except for the date and the judge’s signature. Both parents should sign this form.

In person: Bring the documents listed above to the Family Courthouse. You will file everything

except the Order with the Clerk of Court. All documents are electronically filed and will

be emailed to you after processing. You must provide a valid email address when filing.

Online: You can upload your documents at https://nevada.tylerhost.net/OfsWeb/. There is a

$3.50 fee to e-file your documents. The Order will not be filed until later after the judge

has signed it.

 When you file your documents, you will find out which judge is assigned to your case.

 Take it to the first floor outside the Self-Help Center, and put it in the box that says

“Department Drop Box” (or mail it to the court).

 If the correction is approved, the judge will sign the order. The judge’s staff will send

you a copy of the final order in the mail, or will contact you to pick up and file the order

at the court.

NOTE: The judge may require a hearing if something about your request is not clear, or

if both parents are not agreeing to the change. If so, the judge’s staff will instruct you to

set a hearing. See the Self-Help Center to get an “uncontested setting slip” that you can

use to set a court date.

Get a Certified Copy: The Office of Vital Statistics requires a certified copy of the Order to

Correct Birth Certificate before they will change the birth certificate. You can get a

certified copy at the courthouse for $3. Ask to see the “Records” department to get a

certified copy.

Contact Vital Statistics: Contact the Office of Vital Statistics to have the birth certificate

corrected. You can reach Nevada’s Office of Vital Statistics at

http://dpbh.nv.gov/Programs/BirthDeath/Birth_and_Death_Vital_Records_-_Home/ or by

calling (775) 684-4242.

* You are responsible for knowing the law about your case. For more information on the law, this form, and free

classes, visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road. To find

an attorney, call the State Bar of Nevada at (702) 382-0504.

1

PBC

Name: _________________________

Address: _______________________

City, State, Zip: __________________

Phone: _________________________

Email: _________________________

Self-Represented Petitioner

DISTRICT COURT

CLARK COUNTY, NEVADA

In the Matter of the Application of:

(mother) ___________________________ and

(father) _____________________________

For the Correction of Birth Certificate and

Issuance of New Birth Certificate of:

(Child’s Name)

_

__________________________________

CASE NO.: ____________________

DEPT.: _____________________

PETITION TO CORRECT BIRTH CERTIFICATE

Petitioner(s) (mother’s name) ___________________________________________ and / or

(father’s name) _______________________________________, respectfully state as follows:

1. Petitioner is the natural (☒ check one or both)  mother /  father of the minor child

(child’s full name) _______________________________________________________.

2. The child (child’s name), ________________________________________, was born on

(date of birth) _____________, at (hospital name) _______________________________

located in (county where child was born) __________________ County, State of Nevada.

3. Petitioner and the child have resided in Clark County, Nevada since (date) ___________

and intend to live in Clark County, Nevada indefinitely.

Page 2 of 4 - Petition to Correct Birth Certificate

4. Request for Correction. At the time of the child’s birth, the following information on

the child’s birth certificate was incorrectly entered and needs to be corrected:

(☒ check all that apply)

 Mother’s Information is Incorrect. The mother’s name on the birth certificate is

incorrect. The birth certificate erroneously lists the mother’s name as (write the

mother’s name with the mistakes as it appears on the birth certificate):

Incorrect: ___________________________________________________________

(First) (Middle) (Last)

The correct mother’s name should read:

Correct: ____________________________________________________________

(First) (Middle) (Last)

 Father’s Information is Incorrect. The father’s name on the birth certificate is

incorrect. The birth certificate erroneously lists the father’s name as (write the

father’s name with the mistakes as it appears on the birth certificate):

Incorrect: ___________________________________________________________

(First) (Middle) (Last)

The correct father’s name should read:

Correct: ____________________________________________________________

(First) (Middle) (Last)

A copy of the birth certificate will be filed separately under seal.

Page 3 of 4 - Petition to Correct Birth Certificate

 Other. The birth certificate incorrectly states that (explain what is incorrect on the

birth certificate and what changes need to be made)

___________________________________________________________________

5. Reason. Petitioner requests the above corrections because (explain):

_______________________________________________________________________

6. Parent’s Agreement. (☒ check one)

 Both parents agree to the corrections requested.

 The other parent is not signing this Petition because (explain):

____________________________________________________________________

Petitioner prays for the following:

1. For an Order correcting the minor child’s birth certificate; and

2. For such other relief as the Court finds to be just and proper.

DATED this (day) ______ day of (month) _________________, 20____.

Submitted By: (mother’s signature)_____________________________

(print mother’s name) _______________________________

Submitted By: (father’s signature)______________________________

(print father’s name) _______________________________

Page 4 of 4 - Petition to Correct Birth Certificate

MOTHER’S VERIFICATION

Under penalties of perjury, I declare that I am the Petitioner in the above-entitled action;

that I have read the foregoing Petition and know the contents thereof; that the pleading is true of

my own knowledge, except for those matters therein contained stated upon information and

belief, and that as to those matters, I believe them to be true.

I declare under penalty of perjury under the law of the State of Nevada that the

foregoing is true and correct.

DATED this (day) _____ day of (month) ______________, 20___.

Submitted By: (mother’s signature)  ____________________________

(print your name) _______________________________

FATHER’S VERIFICATION

Under penalties of perjury, I declare that I am the Petitioner in the above-entitled action;

that I have read the foregoing Petition and know the contents thereof; that the pleading is true of

my own knowledge, except for those matters therein contained stated upon information and

belief, and that as to those matters, I believe them to be true.

I declare under penalty of perjury under the law of the State of Nevada that the

foregoing is true and correct.

DATED this (day) _____ day of (month) ______________, 20___.

Submitted By: (father’s signature)  _____________________________

(print your name) _______________________________

ATTACH A COPY OF THE BIRTH CERTIFICATE TO THIS FORM

Your Name: ________________________

Address: ___________________________

City, State, Zip: _____________________

Phone: ____________________________

Email: ____________________________

Self-Represented Petitioner

DISTRICT COURT

CLARK COUNTY, NEVADA

In the Matter of the Application of:

(mother) ___________________________ and

(father) _____________________________

For the Correction of Birth Certificate and

Issuance of New Birth Certificate of:

(Child’s Name)

_

__________________________________

CASE NO.: ____________________

DEPT.: _____________________

COPY OF BIRTH CERTIFICATE

(file under seal)

Attached is a copy of the birth certificate with the incorrect information. This document

is to be kept confidential and filed under seal.

Submitted By: (your signature)____________________________________

(printed name) _______________________________________

1

RSDN

Your Name: ________________________

Address: ___________________________

City, State, Zip: _____________________

Phone: ____________________________

Email: ____________________________

Self-Represented Petitioner

DISTRICT COURT

CLARK COUNTY, NEVADA

In the Matter of the Application of:

(mother) ___________________________ and

(father) _____________________________

For the Correction of Birth Certificate and

Issuance of New Birth Certificate of:

(Child’s Name)

_

__________________________________

CASE NO.: ____________________

DEPT.: _____________________

REQUEST FOR SUMMARY DISPOSITION OF PETITION TO CORRECT BIRTH

CERTIFICATE AND DECLARATION IN SUPPORT

Petitioners, (mother’s name) ____________________________________ and (father’s

name) _____________________________________ requests this Court for a summary

disposition for a correction of birth certificate without a hearing.

Submitted By: (mother’s signature)_____________________________

(print mother’s name) _______________________________

(father’s signature)______________________________

(print father’s name) _______________________________

Page 2 of 2 – Request for Summary Disposition

DECLARATION OF PETITIONER(S)

Petitioners, (mother’s name) ____________________________________ and (father’s name)

_____________________________________ respectfully states as follows:

1. I am the Petitioner in this case. I first moved to Clark County, Nevada on (date)

______________. I intend to live in Clark County, Nevada indefinitely. The child(ren)

in this case are residents of Clark County, Nevada.

2. I have read the Petition to Correct Birth Certificate in this case and can testify that the

allegations are true and correct to the best of my knowledge.

3. The following information on the birth certificate is incorrect and should be changed:

 Mother’s Information is Incorrect. The mother’s name on the birth certificate is

incorrect and should be changed to (write the correct mother’s name):

____________________________________________________________________

(First) (Middle) (Last)

 Father’s Information is Incorrect. The father’s name on the birth certificate is

incorrect and should be changed to (write the correct father’s name):

____________________________________________________________________

(First) (Middle) (Last)

 Other. The birth certificate should be corrected to state that (explain what is

incorrect on the birth certificate and what changes need to be made)

____________________________________________________________________

I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true

and correct.

DATED this (day) ______ day of (month) ______________, 20____.

Submitted By:

 ________________________________

(Mother’s signature)

________________________________

(Mother’s printed name)

 ________________________________

(Father’s signature)

________________________________

(Father’s printed name)

1

ORDR

Your Name: ________________________

Address: ___________________________

City, State, Zip: _____________________

Phone: ____________________________

Email: ____________________________

Self-Represented Petitioner

DISTRICT COURT

CLARK COUNTY, NEVADA

In the Matter of the Application of:

(mother) ___________________________ and

(father) _____________________________

For the Correction of Birth Certificate and

Issuance of New Birth Certificate of:

(Child’s Name)

_

__________________________________

CASE NO.: ____________________

DEPT.: _____________________

ORDER FOR CORRECTION OF BIRTH CERTIFICATE

This Order was submitted ( check one)  after a hearing /  without a hearing before

the above-entitled court, and after a review of the pleadings and papers on file and the testimony

given, if any, this Court finds that a clerical error was made on the original birth certificate of

the minor child, (child’s name) ___________________________________________, born on

(date of birth) ________________ at (hospital name) _______________________________

located in (county where child was born) __________________ County, State of Nevada. It is

in the best interest of the child to have the information on the birth certificate corrected and a

new birth certificate issued.

Page 2 of 3 - Order for Correction of Birth Certificate

IT IS HEREBY ORDERED, ADJUDGED AND DECREED that the birth certificate

of the minor child, (child’s name) ___________________________________________, shall be

corrected as to the name of the mother. The name shall be corrected from:

(Incorrect Name) ______________________________________________________________

(First) (Middle) (Last)

To:

(Correct Name) _______________________________________________________________

(First) (Middle) (Last)

IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the birth certificate

of the minor child, (child’s name) ___________________________________________, shall be

corrected as to the name of the father. The name shall be corrected from:

(Incorrect Name) ______________________________________________________________

(First) (Middle) (Last)

To:

(Correct Name) _______________________________________________________________

(First) (Middle) (Last)

IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the following

corrections shall also be made to the above-named child’s birth certificate (explain any other

corrections, or write “n/a” if none) _________________________________________________

______________________________________________________________________________

Page 3 of 3 - Order for Correction of Birth Certificate

IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the Department of

Vital Statistics shall issue a new birth certificate for the above-named child reflecting the

corrections above.

DATED this (day) ______ day of (month) ______________, 20____.

____________________________________

DISTRICT COURT JUDGE

Submitted By:

 ________________________________

(Mother’s signature)

________________________________

(Mother’s printed name)

 ________________________________

(Father’s signature)

________________________________

(Father’s printed name)

Case Number: _________________________

(to be assigned by the Clerk’s Office)

Nevada AOC – Research & Statistics Unit Revised 03/2019

Pursuant to NRS 3.275

CLARK COUNTY, NEVADA

FAMILY COURT COVER SHEET

PARTIES:

Plaintiff/Petitioner Defendant/Respondent/Co-Petitioner/Protected Person

Last Name: Last Name:

First Name: Middle Name: First Name: Middle Name:

Mailing Address: Mailing Address:

City, State, Zip: City, State, Zip:

Phone #: Date of Birth: Phone #: Date of Birth:

Email Address: Email Address:

Attorney Information not applicable Attorney Information not applicable

Name: Bar No. Name: Bar No:

Address: Address:

City, State, Zip: City, State, Zip:

Phone #: Phone #:

CASE TYPE: (Check only one box only for the primary type of case you are filing)

DISSOLUTION

MISC. DOMESTIC RELATIONS

PETITIONS

GUARDIANSHIP OTHER

Annulment

Divorce –No minor child(ren)

Divorce –With minor child(ren)

Foreign Decree

Joint Petition –No minor child(ren)

Joint Petition – With minor child(ren)

Separate Maintenance

Adoption –Minor

Adoption –Adult

Child Custody (non-divorce)

Child Support (private party)

Mental Health

Name Change

Paternity

Permission to Marry

Temporary Protective Order (TPO)

Termination of Parental Rights

(private party)

Termination of Parental Rights

(State initiated)

Visitation (non-divorce)

Other (identify) __________________

Guardianship of an Adult

Person

Estate

Person and Estate

Guardianship of a Minor

Person

Estate

Person and Estate

Guardianship Trust

DA Child Support

DA – UIFSA

DA – Child Support In State

DA Child Dependency

DA – Abuse/Neglect

DA – No Fault

DA – Other (identify)

__________________

Juvenile

Emancipation

CHILDREN INVOLVED IN THIS CASE (if applicable)

Last Name First Name Middle Name Date of Birth Relationship

1.

2.

3.

4.

5.

6.

7.

8.

Does this family have any other current or past case(s) in the Clark County Family Court or Juvenile Court?

YES NO

_________________________________ __________________________________ ________________

Your Printed Name Your Signature Date

Birth Certificate

Fill Online, Printable, Fillable, Blank Filing Fee: The filing fee is $270. About (Family Law Self Help Center) Form

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Fillable Filing Fee: The filing fee is $270. About (Family Law Self Help Center)

Fill Online, Printable, Fillable, Blank Filing Fee: The filing fee is $270. About (Family Law Self Help Center) Form

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