Application for Correction of Certificate of Birth
NEW YORK STATE
DEPARTMENT OF HEALTH
VITAL RECORDS SECTION
APPLICATION FOR CORRECTION OF CERTIFICATE OF BIRTH
RE: INFANT-
DATE OF BIRTH-
PLACE OF BIRTH-
FATHER'S NAME-
MOTHER'S NAME -
DISTRICT NUMBER -
REGISTER NUMBER -
BIRTH NUMBER-
Please correct the certificate of birth identified above, as follows:
ITEM IN ERROR
(Or Omitted)
AS IT APPEARS
AS IT SHOULD BE
Documentary evidence submitted herewith in support of this application includes:
EXPLAIN REASON FOR ERROR OR OMISSION:
To be completed by applicant:
Under the penalties of perjury, I hereby affirm that the statements made herein are true and correct to the best of
my knowledge.
SIGNATURE OF APPLICANT
RELATIONSHIP TO INFANT
DATE
ADDRESS
To be completed by registrar of vital statistics:
The above information has been added to the local record of birth on file in this office.
SIGNATURE OF REGISTRAR
DISTRICT NUMBER
DATE
DOH-297 (1/2002) Page 1 of 2
(OVER)
INSTRUCTIONS
TO PERSON REQUESTING CORRECTION..
Neither the State Department of Health nor the local registrar of vital statistics has the authority to alter or change
information on a certificate as filed, except to correct errors or to add information that was not available at the time the
certificate was filed, unless directed to do so in an order from a court of competent jurisdiction. If an error was made at
the time the original certificate was completed, this form should be completed by the physician or other attendant at birth
who signed the certificate. In the event the physician or other attendant at birth is not available, then the parents or
individual if 18 years of age or over may Gomplete the form but must submit satisfactory documentary evidence to support
the correct information. The documentary evidence must be a record made near the date of birth, such as a hospital
record, church or synagogue record, school record, state or federal census record, etc. For expedited service, return this
form to the local registrar where the birth occurred. Or send to: Correction Unit, Vital Records Section, P.O. Box 2602,
Albany, NY 12220-2602.
THIS FORM MAY NOT BE USED TO CHANGE NAMES.
OTHER FORMS ..
DOH.3645.. Used by parents to add a given name of child to a birth certificate.
DOH.2739.. Used by putative father who wishes to consent to having his name on the certificate of birth
of a child born to an unwed mother.
DOH.1927.. Used by previously unwed parents who marry after birth of child who wish to add natural father's
name to a birth certificate. Certified copy of marriage record also required.
CHANGE OF INFORMATION ..
A certified copy of the court order must be presented to the State Department of Health to change information
on a birth certificate in matters relating to:
1) Adoption
2) Determination of parentage
3) Change of name
4) Change of fictitous names
TO REGISTRAR OF VITAL STATISTICS--
If this form is returned to you satisfactorily completed and the documentary evidence, if required, is from some
authoritative source and supports the information to be corrected or added to the local record and the original certificate,
enter the information in the local record and issue copies thereof immediately. Sign the bottom of the form and send
it to the State Department of Health immediately, along with the documentary evidence so that the original certificate
may also be amended. If you wish to have the correction form and evidence offered reviewed before you amend the
local record and issue copies thereof, send it to the State Department of Health but do not sign your name on the
bottom of this form. In this case you will be notified by the State Department of Health as to whether or not the original
certificate and your local record should be amended.
DOH-297 (1/2002) Page 2 of 2
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Listing of Supporting Documents Which
May be Submitted with the
Application for Correction of Birth, DOH-297
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1 Hospital Record of the Birth. Certified by custodian of the hospital records.
2. Certified Copy of Attending Physician's Office Record of the Birth.
3. Baptismal Certificate or Other Church or Synagogue Record made when the person, whose record IS to be
corrected, was under 12 years of age. The record must bear the raised seal of the Church or Synagogue; if
there IS no seal, it must be made on the stationery of Church or Synagogue.
4. New York State Census Record. A State census was taken on the following dates: February 14, 1892; June 1,
1905; June 1, 1915 and June 1, 1925. A record may be obtained from the County Clerk of the County where the
person whose certificate IS to be corrected lived on those dates. A record from the 1915 and 1925 census may
also be obtained by writing to the State Archives and Records Administration, Empire State Plaza, Albany, New
York, 12230. In writing to the County Clerk or State Archives and Records Administration, give the full name of
the person, the names of parents and exact address at which he/she lived on the date the State census was
taken. It IS preferred that the record be from the first census taken after the date of birth.
5. Federal Census Record. A Federal census was taken on the following dates: June 1, 1990; April 15, 1910;
January 1, 1920; April 1 , 1930, 1940, 1950, 1960 and 1970. A record may be obtained by writing to the U.S.
Census Bureau, Pittsburgh, Kansas 66762, giving full name of the person whose certificate is to be corrected,
the names of parents and exact address at which he lived on the dates when a census was taken. It IS preferred
that the record be taken from the first census after the date of birth. Because of the heavy demand, it may take a
month or longer to receive the census record. There is a fee for this service. The fee must be In the form of a
money order or check, payable to Census, Department of Commerce.
6. School Record. Made on the stationery of the school. The record should include the full name of the child; the
date of birth or age, date the document was made and the names of the parents. This document must have
been established prior to age 12 of the applicant.
7. Naturalization Certificate of Father and/or Mother (for correction of family surname or parents' name) Must
send original Certificate to this office by Registered Mail as it IS illegal to make photocopies of a Naturalization
Certificate. After review, the certificate will be returned to you by Registered Mail.
8. Certified Copy of Official Marriage Record of the Parents. If the marriage occurred In New York (outside of
New York City), send only the names of the bride and groom, the place where the marriage license was issued
and the date of marriage. Marriage must have occurred before the child was born.
9. Certified Copy of a Birth Certificate of Older Brother or Sister of the Person Whose Birth Certificate is to
be Corrected. If the birth occurred in New York State (outside of New York City), send only the name of the
child, date and place of birth. This certificate, In order to be acceptable, must have been correctly registered at
the time of the birth. An amended birth certificate of older brother or sister may not be acceptable for correction.
10. Certified copy of Birth Certificate of Mother of the Person whose Birth Certificate is to be corrected.
If the birth occurred in New York State (outside of New York City), send only name of mother, date and place of
birth as it appears on record.
11 Certified copy of Birth Certificate of Father of the Person whose Birth Certificate is to be corrected.
If the birth occurred in New York State (outside of New York City), send only name of father, date and place of
birth as it appears on record.
Send Application to Correct Birth Certificate and Supporting Documents to:
Correction Unit Local Registrar of Vital Statistics
Vital Records Section OR (where the birth occurred)
P.O. Box 2602
Albany, NY 12220-2602
DOH-297(i} (06/2003)