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COMMONWEALTH OF VIRGINIA APPLICATION FOR CERTIFICATION OF A birth RECORD Virginia statutes require a fee of $ be charged for each certification of a vital record or for a search of the files when no certification is made. Please make check or money order payable to State Health Department. There is a $ service charge for returned checks. IMPORTANT: The person requesting the vital record must submit an enlarged, legible (readable) and clear photocopy of their identification. REQUESTER INFORMATION DAYTIME PHONE NUMBER Check this box to receive text notifications.

A written request detailing the item to be amended on the birth certificate, $12 fee and requester's ID. The written request should also include the name of the registrantand date and place of birth, parent name as it appears on the birth certificate. Change of Gender . COG : Amending the gender on the birth certificate

  Birth, Date, Gender

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