VR 172 (Rev. 6/22)
6
Table A
I am the I want to What documents do I need?
(See description of documents below.)
Person named on the
certificate or parent(s)
of child named on the
certificate. If parent,
child must be younger
than 18 years old.
If the error was made by
the hospital, go to Table D
in this application.
1. Add or correct the first or middle name
on the birth certificate.
1, 2, 3, 4, 5 or 6
(Also see “Note for documents 1 to 6” under
the list of documents table below.)
2. Change the name on the birth certificate
(first, middle and/or last name; legal
name change).
12
3. Correct the parent information on the
birth certificate (spelling of parent
names; parent date and place of birth).
7, 9 or 13
4. Correct the last name on the
birth certificate.
7a, 8, 9, 10 or 11
All documents must be dated prior to
the date of birth.
If the error was made by the hospital, go to Table D in this application.
List of documents accepted by the NYC Department of Health and Mental Hygiene
# Type of document(s) accepted
1* Immunization record showing child’s first name, date of birth, name of parent listed on the birth certificate and
the health care facility’s stamp. The immunization record must be at least 10 years old.
2* First census record taken after birth (federal or state)
3* Letter from a physician showing your date of birth and correct name. The letter must be on letterhead and
indicate that you were treated by the physician 10 or more years ago. It must include the date of your first visit
and the date of your last visit.
4* Letter from an elementary, middle or high school that you attended showing your date of birth and correct name.
The letter must indicate the dates that you were registered and must be from a school that you attended 10 or
more years ago.
5* A letter or document from a religious institution showing your date of birth and correct name. The document
must be at least 10 years old and on official letterhead.
6* Your life insurance policy showing your date of birth and correct name. The policy must be at least 10 years old.
7 Original birth certificate of the parent whose information you would like to correct.
7a Birth certificate of parent showing the correct spelling of last name. The certificate must be dated prior
to the date of birth.
8 Passport of the parent showing the correct spelling of last name. The passport must be issued prior
to the date of birth.
9
Parent’s original marriage record/certificate if parents were married before the child was born. This can only
be used to correct a last name.
10 Parent’s U.S. Naturalization Certificate. The information on the naturalization certificate must match the parent
information on the birth certificate. The parent’s last name on the naturalization certificate must match the
requested correction. The naturalization certificate must be dated prior to the date of birth.
11 Birth certificate of an older sister or brother with the same parent.
12 Obtain a certified legal name change court order. If you live in NYC, you must go to Civil Court and request a legal
name change. If you live outside of NYC, go to the appropriate court in your area and request a legal name change.
The certified legal name change court order must include the date of birth, place of birth and certificate number.
13 Any of the following:
• Birth certificate of the parent whose information you would like to correct
• Birth certificate of an older sister or brother with the same parent
• Religious institution showing your date of birth, your correct name and parent’s correct name(s)
• Naturalization certificate or marriage record before the child was born; may be used to correct last name only
* Note for documents 1 to 6: Generally, a document must have been established prior to the child’s 7th birthday or it must be at least
10 years old. This helps us establish that the documentation you are submitting is legitimate. Documents should also include the
following: child’s name; listed date of birth; parent name(s).