The document provides instructions for completing a sworn statement required for obtaining certified copies of birth, death, or marriage certificates in California. It outlines who qualifies as an authorized person to request these records, the notary requirements, and the necessary documentation. Additionally, it includes a sworn statement form that must be notarized to validate the request.
The document provides instructions for completing a sworn statement required for obtaining certified copies of birth, death, or marriage certificates in California. It outlines who qualifies as an authorized person to request these records, the notary requirements, and the necessary documentation. Additionally, it includes a sworn statement form that must be notarized to validate the request.
The document provides instructions for completing a sworn statement required for obtaining certified copies of birth, death, or marriage certificates in California. It outlines who qualifies as an authorized person to request these records, the notary requirements, and the necessary documentation. Additionally, it includes a sworn statement form that must be notarized to validate the request.
The document provides instructions for completing a sworn statement required for obtaining certified copies of birth, death, or marriage certificates in California. It outlines who qualifies as an authorized person to request these records, the notary requirements, and the necessary documentation. Additionally, it includes a sworn statement form that must be notarized to validate the request.
State of California – Health and Human Services Agency California Department of Public Health
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).
VS 20 (1/20) Page 1 of 2 State of California – Health and Human Services Agency California Department of Public Health
SWORN STATEMENT I, , declare under penalty of perjury under the laws of the (Applicant’s Printed Name) 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):
Registrant Applicant's Relationship to Registrant (Name of person whose certificate (Must be an authorized person) you are requesting)
(The remaining information must be completed in the presence of a Notary Public or CDPH Vital Records staff.)
Subscribed to this day of , 20 , at , .
(Day) (Month) (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, , personally appeared , (Insert name and title of the officer) 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)
CASE #21 HEIRS OF SOLEDAD ALIDO vs. FLORA CAMPANO or Her Representatives, and The Register of Deeds, Province of Iloilo G.R. No. 226065, July 29, 2019 Facts
