PAGE 1 OF 7 OFFICE OF VITAL RECORDS 01/2024
▪ First, middle, last name and name suffix
(amending a full name requires court order)
▪ Date of birth
▪ Time of birth
▪ Plurality (i.e., single birth, twin birth, triplet)
▪ Sex
▪ Place of birth
Birth Record Amendment Packet
Any corrections or additions to a birth record require an amendment, when the changes happen after a
birth certificate has been purchased OR after the child’s first birthday, whichever comes first. Fill out the
form below and provide supporting documents to request an amendment to a Minnesota birth record.
You may request amendments for the following information on the birth record:
Child’s/subject’s information Parent’s information
▪ Names (first, middle, last, or name suffix –
changing entire name requires court order)
▪ Names at birth (name before first marriage)
▪ Date of birth
▪ Place of birth
Format changes, such as requests for upper case/lower case letters are not valid amendment requests.
Minnesota birth records print in all capital letters as a best practice set by U.S. vital records standards
organizations.
List each item you want to amend on a separate line as shown below. In the right column, print how you
want the item to show on the new certificate. The third page of the application has space for additional
items to amend.
Supporting documents
Amendments require supporting documentation.
You must send at least one supporting document to add missing information to a birth record.
You must send in at least two supporting documents to change information on a birth record.
Each document must:
1. Show the item you want to add or change exactly as you want it to appear on the new birth
certificate, AND
2. Show at least two items that match what is on the birth certificate already that you are not asking to
have changed.
BIRTH RECORDS AMENDMENT INSTRUCTIONS AND REQUEST
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Documents need to show at least two items from this list:
• subject’s last name
• subject’s date of birth
• subject’s place of birth
• a parent’s name
• a parent’s date of birth
• a parent’s place of birth
Documents must be What does this mean?
Legible We can make out the letters and words; document is sharp – not blurred or smeared
Unmodified No erasures: nothing crossed out; no correction tape or fluid
Original No copies – must provide, for instance, actual passport or certificate of naturalization
Certified
Birth, death, or marriage certificates; military discharge forms; and court orders must
be issued by a government office. Certified documents usually have a stamp or seal.
Authenticated
Authenticated means an employee from the place giving you the record declares in
writing that the document they are providing you is a true and exact copy of the
record on file. At minimum, an employee of the organization must list the name and
address of the organization on the document, and sign and date it.
In English
Documents must be in English or translated into English. A qualified translator must
translate the document and sign it in front of a notary public.
Depending on subject’s
age, created within a
certain number of years
from birth OR a certain
number of years before
your request
If the subject is younger than seven years old, the document must be from the subject’s
first year of life OR at least one year before you signed the amendment application.
If the subject is seven or more years old, the document must be from before the
subject’s third birthday OR at least seven years before the date you signed the
amendment application.
Acceptable supporting documents
The Office of Vital Records accepts the document listed below and may determine other documents are
acceptable. Documents must meet all the requirements above and support the requested amendment.
▪ Authenticated U.S. K-12 school record, or official college transcript
▪ Authenticated hospital, clinic, or social services record
▪ Valid (unexpired) passport – NOT a notarized photocopy
▪ Original or certified copy of U.S. military discharge papers (such as a DD214 form)
▪ Certified (government issued) copy of a marriage certificate
▪ Certified court orders from a U.S. court that:
▪ Show the subject’s name and date of birth as they currently appear on the birth record
▪ Clearly specify which items to amend on the birth record (if amending information other the
subject’s name)
▪ Certified copy of a birth certificate of a child
▪ Certified copy of a birth certificate of a parent or sibling (only to amend parent information)
▪ U.S. baptism certificate or other church record and the church’s phone number (to verify record)
BIRTH RECORDS AMENDMENT INSTRUCTIONS AND REQUEST
PAGE 3 OF 7 OFFICE OF VITAL RECORDS 01/2024
▪ Original or certified copy of a Certificate of Naturalization AND certified Petition for Name Change
▪ Official tribal enrollment record
▪ Numident record (https://secure.ssa.gov/poms.nsf/lnx/0203325025) from the U.S. Social Security
Administration
Documents NOT accepted
Hospital souvenir birth certificate
Driver’s license
State, employee, or other id card or permit
Social security card or statement
Application of any kind
Insurance card or policy
Paycheck stub
Tax return
Statement or bill
Newspaper article
Gender
To change the subject’s sex on a birth record, the requester must send our office either of the following:
▪ An original letter from and signed by a licensed physician that:
▪ References the subject’s name and date of birth on the current birth record and,
▪ Certifies that the subject has had “appropriate clinical” treatment for gender transition.
OR
▪ A certified copy of a court order that specifically directs amendment of the subject's sex on the
birth record.
Changing parent names on record
A court order is required to change the full name of a parent on a subject’s birth record. The court order
must:
▪ Spell out the parent’s name(s) before and after the name change, and
▪ Direct the Office of Vital Records to change the parents’ names on the child’s birth record.
A court order to change the parents’ names on multiple birth records must list each child’s name.
Please note
▪ Fees are not refundable.
▪ Birth record amendment requests can only be fulfilled by the Office of Vital Records (Minnesota
Department of Health); they are not available through county vital records offices.
▪ We will return your application along with your supporting documents if the application is not filled
out completely, your payment is insufficient, or supporting documents are not adequate for the
request.
▪ Pay one $21 express delivery fee if you asked for changes to multiple birth records. Documents must all
go to the same address.
▪ Unresolved requests will be closed 12 months after we receive them. Once a request is closed,
customers must submit a new request and pay the fee again to update the record and/or receive
the vital records.
BIRTH RECORDS AMENDMENT INSTRUCTIONS AND APPLICATION
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▪ Be sure to sign the application in front of a notary public
(https://www.health.state.mn.us/people/vitalrecords/notary.html).
▪ The fee for reviewing and processing the amendment is non-refundable and does not include the
cost of a new birth certificate. Do not send cash as payment.
▪ Include a prepaid express delivery envelope with your application if your supporting documents or
new certificates are going to an address outside the U.S.
▪ Ensure that your supporting documents meet all the requirements listed above. We will return your
original documents when we finish processing your request.
▪ Find information on getting a Minnesota court order at Minnesota Judicial Branch
(https://mncourts.gov/).
Call 651-201-5970 or email health.vitalrecords@state.mn.us with questions.
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Birth Record Amendment Request
Use this form to request additions or changes to information on a Minnesota birth record. You must also provide
documents that support the requested amendments (see instructions). It’s illegal to give false information to amend a
vital record, and it may subject you to fines, jail time, or both.
What does the birth record show now?
Child/Subject
Child/Subject first name
Child/Subject middle name
Name suffix
Date of birth (MM/DD/YYYY)
Sex
Minnesota city of birth
Minnesota county of birth
Parents
First name of parent one
Middle name of parent one
Last name of parent one
Last name before 1
st
marriage
First name of parent two
Middle name of parent two
Last name of parent two
Last name before 1
st
marriage
List each item to amend separately.
See the instruction sheet.
How should information show on the new certificate?
See the instruction sheet.
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
To amend additional items, see the last page of the form.
Requester Information – What is your relationship to the subject of the birth record?
By law, only the birth record subject, their parent, or their legal guardian or representative may request amendments.
☐ I am the subject of the record and 18 or older (if you have a court order, you - not your parent - must be requester)
☐ I am a parent listed on the record
☐ I am the legal guardian or legal representative of the subject.
You must send a certified copy of the U.S. court order
with the application. The court order must name you as the legal guardian or list you as the legal representative.
Requester full name
Date of birth (MM/DD/YYYY)
Street address (Express delivery services won’t deliver to PO boxes or APO addresses.)
Apt/Unit #
City
State
Zip code
Daytime Phone (10-digit)
Email
REQUIRED – Sign this form in front of a notary public
I certify that the information provided on this application is correct and complete to the best of my knowledge.
Requester signature
Notary Stamp/Seal
Notary
Signed or attested before me on the day of , 20
Printed name of notary public
Notary public signature
My commission expires
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Requester Name:
Fees and records request
Fee
Amendment request processing
$40 $40
First amended birth certificate $26
Additional birth certificates
# of extra copies
$19 each
Processing
Fee
Standard — request processed in the order received $0
Faster — request handled ahead of standard requests (doesn’t include express delivery)
$20
Shipping
Fee
Regular first-class mail $0
Express delivery (Check here
☐
to require a signature.)
$21
The Office of Vital Records and the express delivery service are not responsible for deliveries that do not require a
signature. Express delivery services will not deliver to PO boxes or APO addresses.
For delivery outside the United States, you must supply a prepaid express delivery envelope with your application.
Total due
Fees are due with the application and are non-refundable.
Payment method
☐ Credit card
MasterCard/VISA/Discover
Cardholder name
Valid thru
(MM/YY)
Card number
3-digit
code
☐ Check
Check #
Make check or money order payable to Minnesota
Department of Health. DO NOT SEND CASH. Checks
returned for non-
payment will result in a $30 charge to
you. You could also face civil penalties.
☐ Money order
Money order#
Send your application and payment to:
Incomplete requests
Minnesota Department of Health
Office of Vital Records
Mail: PO Box 64499, St. Paul, MN 55164-0499
Courier/express delivery: 625 Robert St. N, St. Paul, MN
55155 (no vital-records counter service at this location)
The
Office of Vital Records returns applications that
are incomplete, not signed in front of a notary public,
or not paid in full at the time of application.
Unresolved requests will be closed 12 months after we
receive them. Once a request is closed, customers
must submit a new request and pay the fee again to
update the record and/or receive the vital records.
If you have questions, contact the Office of Vital Records at health.vitalrecords@state.mn.us or 651-201-5970.
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AGE 7 OF 7 OFFICE OF VITAL RECORDS 01/2024
Birth Record Amendment Application
(Use this page ONLY if you filled all the rows on the first page of the application.)
Requester Name:
List each item to amend separately
See the instruction sheet.
How should information show on the new certificate?
See the instruction sheet.
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as
Item to amend
Show on new certificate as