DPH Birth Certificate Application – San Francisco, CA

What is SF VS 111?

Who needs to file SF VS 111?

When to file SF VS 111

Documents you need

• Sworn Statement (page 2), signed by the applicant and notarized by a U.S. Notary Public: required for a Certified Copy submitted by mail, unless you are law enforcement or a local or state governmental agency.
• Fee for each copy requested, as a personal check preprinted with the account holder's name from a U.S. bank or a money order from a U.S. institution, payable to SF Department of Public Health. No cash.
• Self-addressed prepaid stamped return envelope, enclosed with the application and fee.
• Prepaid return air bill (Federal Express, USPS Priority, UPS or other): only if you want return tracking or guaranteed delivery.
• Documentation of guardianship: only if you apply as a legal guardian of the registrant.
• Copy of the court order: only if you apply as a party entitled to the record by court order.
• Authorization from the government agency: only if you are a company representing a government agency. A business card is not accepted.
• Copy of the power of attorney, or documentation identifying you as executor of the estate: only if you apply under those appointed rights.
• Court order releasing the original sealed record: only if you request a copy of the original birth certificate of an adopted registrant.

How to fill out SF VS 111

1. 1

   Choose the type of copy

   On page 1, mark I want a Certified Copy or I want a Certified Informational Copy. The informational copy is printed "INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY" and needs no Sworn Statement.

2. 2

   Select your relationship to the registrant

   Under To receive a Certified Copy, I am, mark the one authorized relationship that fits you. Add the supporting documents the form asks for, such as guardianship papers, a court order or a power of attorney.

3. 3

   Enter applicant and agency details

   Under Applicant Information, enter today's date, your printed name, mailing address, email address and daytime telephone with area code. Fill in Agency Name, Agency Case No. and Purpose of Request only if they apply.

4. 4

   Enter copies and amount enclosed

   Enter the Number of Copies and the Amount Enclosed. If the copies go to someone else, fill in the name and mailing address for copies, if different from the applicant.

5. 5

   Describe the birth record

   In Birth Record Information, enter the registrant's first, middle and last name, the date of birth as MM/DD/CCYY (an approximate date if unknown), sex, and whether the record was amended. City and county of birth are preprinted as San Francisco.

6. 6

   Add parent details and adoption status

   Enter the father/parent and mother/parent names, using the mother's birth name. Mark Adopted Yes or No; if Yes, read instruction #4 and request the adopted name.

7. 7

   Sign the application

   Sign in Signature of Applicant. Leave the For Office Use Only box blank.

8. 8

   Complete the Sworn Statement

   For a Certified Copy, print your name, the registrant's name and your relationship on page 2. Sign the Subscribed line with the day, month, city and state, in the presence of a Notary Public or SFDPH staff.

9. 9

   Have the notary complete the acknowledgment

   If you are mailing the application, a U.S. Notary Public must complete the Certificate of Acknowledgment. Law enforcement and local and state governmental agencies are exempt from this requirement.

10. 10

    Review, download and assemble the package

    Check that names, dates and the relationship match. Download or print the completed PDF from FillingPDF, then add the fee and return envelope as described under How to submit.

How to submit SF VS 111

Common mistakes to avoid

• Mailing a request for a Certified Copy with a Sworn Statement that is not notarized; the form requires notarization for mailed applications unless you are a governmental agency.
• Choosing Certified Copy without marking your relationship to the registrant from the list on page 1 and completing the Sworn Statement.
• Listing a relationship on the Sworn Statement that is not one of those printed on page 1 of the application.
• Putting several birth records on one application; the instructions require a separate application for each record.
• Sending cash, a foreign check or an international money order instead of a preprinted U.S. check or U.S. money order.
• Leaving out the self-addressed prepaid stamped return envelope.
• Giving incomplete or inaccurate birth record details; the office may not be able to locate the record.
• Entering a city of birth other than San Francisco; the form says the city of birth must be in San Francisco.
• Using a notary acknowledgment executed outside the USA instead of a U.S. consular officer or an eligible judge's certification.