āAs there is no statutory authority pertaining to ledger book records, forms VS 60 ā Ledger Book Record of California Marriage, VS 61 ā Ledger Book Record of California Birth, and VS 110 ā Ledger Book Record of California Death are not valid and should no longer be used.
Records of events predating July 1905 are not maintained by the State Registrar. Pursuant to Health and Safety Code (HSC) 102370, counties that have records existing prior to July 1905 are retained as special county records. Therefore, because special county records exist solely as county records, it is at the discretion of each county on how to issue certified copies of records predating July 1905 that are not maintained by the state registrar.
The VS140e Forms Request has been updated to reflect this change.
If there are any questions regarding this information, please contact the CDPH-VR, Quality Assurance and Production Section at (916) 552-8116.
Sincerely,
Original signed by:
Dana E. Moore, MPH, CPH
State Registrar
Deputy Director
Chief Data Officer
Center for Health Statistics and Informatics
Attachments:
VS 140e ā Forms Request:
State of CaliforniaāHealth and Human Services Agency, Department of Public Health
CDPH Office of Vital Records
FORMS REQUEST
MAIL:
CA Dept. of Public Health
Vital Records Stockroom
P.O. Box 997410, MS 5103
Sacramento, CA 95899-7410
EMAIL: vsforms@cdph.ca.gov
Most forms can be obtained from the link below:
https://www.cdph.ca.gov/āPrograms/PSB/Pages/BirthDeathMarriageCertificates.aspxā
FAX: (916) 324-0122ā
ā
County / Office:
Street Address:
City, State, Zip:
Contact:
(Name, Phone, Date)
NOTE: DO NOT USE P.O. BOXāSTREET ADDRESS ONLY
ā
Please retain a copy of this form for your files.
āblank
| āVS 9(e)
| āApplication and Permit for Disposition of Human Remains (01/08) (e-form only)
| āblank
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| VS 10A(e)
| Certificate of Live Birth & Fetal Death - Medical Data Supplemental Worksheet (01/06) (e-form only) | blank
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blank | VS 10D | Certificate of Live Birth (05/22) | blank |
blank | VS 11 | Certificate of Death (03/06) | blank |
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| VS 11e
| Certificate of Death (12/04) ā (prints back side only-EDRS use) | blank |
blank
| VS 12
| Certificate of Fetal Death / Worksheet (08/07) | blank
|
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| VS 12e
| Certificate of Fetal Death (08/07)ā (prints back side only-FDRS use) | blank
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| VS 21
| Application to Amend a Birth Record- Adjudication of Facts of Parentage (04/20) (e-form only) | blank
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| VS 22
| Acknowledgement of Paternity/Parentage (04/20) (e-form only) | blank |
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| VS 23
| Application to Amend a Birth Record After a Court Order Name Change (01/23) (e-form only)ā
| blank
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| VS 24
| Affidavit to Amend a Death Record (01/22) (e-form only) | blank |
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| VS 24A
| Physician/Coroner's Amendment (01/08) (e-form only) | blank |
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| VS 24B
| Application to Amend a Birth Record (01/23) (e-form only) | blank
|
blank | VS 24C | Application to Amend a Marriage Record (01/23) (e-form only) | blank
|
blank | VS 44
| The Adoption Process (06/22) (e-form only) | blank
|
blank | VS 85 | Delayed Registration of Birth (01/22) (e-form only) | blank
|
blank | VS 105 | Court Order Delayed Registration of Fetal Death (01/22) (e-form only) | blank
|
blank | VS 106(e) | Local Registrar's Transmittal Report (03/08) (e-form only) | blank
|
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| VS 107
| Supplemental Name ReportāBirth (01/23) (e-form only) | blank |
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| VS 108 | Court Order Delayed Registration of Birth (01/22) (e-form only) | blank |
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| VS 109 | Court Order Delayed Registration of Death (01/22) (e-form only) | blank
|
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| VS 115
| License and Certificate of Marriage for Denominations Not Having Clergy (01/10) | blank
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| VS 116
| License and Certificate of Declaration of Marriage (01/10) | blank
|
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| VS 117
| License and Certificate of Marriage (01/10) | blank
|
blank | VS 117B(e)
| Application for License to Marry (01/09) (e-form only) | blank
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| VS 118(e)
| Souvenir Marriage Certificate (e-form only) | blank
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| VS 122
| Court Order Delayed Certificate of Marriage (01/22) (e-form only) | blank |
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| VS 123
| License and Certificate of Confidential Marriage (01/15) | blank
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| āVS 136
| āCertificate of Finding of Unknown Child or Safely Surrendered Child (01/08)
| āblank
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| āVS-PUB 109
| āBlank Amendment Paper (28 lb. white ledger)
| āblank
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āVS 140e (08/2023)
23-11 Attachment 1 VS 140e (08-2023) Fillable Formā
āCDPH Vital Records, MS 5103 ā P.O. Box 997410 āā Sacramento, CA 95899-7410
(916) 552-8116 ā (916) 552-8170 FAX
Internet Address: www.cdph.ca.govā