VS 12 at a glance
What it is: Application for Certified Copy of Fetal Death Record of the California Department of Public Health, which has maintained fetal death records since July 1, 1905.
Who signs: Complete the Applicant Information section and provide your signature where indicated.
Information contained in vital records is released only via requests for certified copies. Certified copies of still births are available for release to the mother/parent or father/parent only. Certified copies of fetal death certificates are available for release to anyone who can provide sufficient information to identify a specific record.
Complete a separate application for each fetal death record requested.
A filled-in VS 12 example: one copy of a fetal death record
How to fill out VS 12, box by box
Applicant information
Under APPLICANT INFORMATION (PLEASE PRINT OR TYPE), enter Today's Date, Agency Name (if applicable), Agency Case Number and Inmate ID Number.
Enter Print Name of Applicant, Purpose of Request, Mailing Address - Number, Street and Amount Enclosed - DO NOT SEND CASH, and sign the Signature of Applicant box.
Enter City, State/Province, ZIP Code, Daytime Telephone Number, Country and Email Address.
Number of copies, money order and CNPR request
If you require documentation that a fetal death record does not exist, check the box for CNPR (Certificate of No Public Record) Request.
If no fetal death record is found, the fee will be retained for searching the record (as required by law) and a "Certificate of No Public Record" will be issued to the applicant.
Submit $18 for each copy requested (checked November 7, 2026).
Indicate the number of copies you want and include the correct fee(s) in the form of a personal check or postal or bank money order (International Money Order for out-of-country requests) made payable to CDPH Vital Records.
Submit check or money order, do not send cash (CDPH cannot be held responsible for fees paid in cash that are lost, misdirected, or undelivered).
Fees are non-refundable per state law.
Person receiving copies
Enter Name of Person Receiving Copies, Mailing Address for Copies, City, State and ZIP Code, if Different from Applicant.
Fetal death information
In the Fetal Death Information section, provide all the information you have available to identify the fetal death record, as shown on the fetal death record, to the best of your knowledge.
Enter FETAL DEATH FIRST Name, MIDDLE Name and LAST Name.
Enter City of Fetal Death (must be in California) and County of Fetal Death.
Enter Date of Fetal Death as MM/DD/CCYY (If unknown, enter approximate date of fetal death).
Enter Father/Parent and Mother/Parent FIRST Name, MIDDLE Name and LAST Name (Before Marriage/Domestic Partnership).
Be sure to complete all items required on the application, and provide as much information as possible to help locate the record, otherwise your request may be returned to you for correction.
More rules for VS 12
Please allow a few weeks to receive these documents.
If your situation is different
The record is a still birth
For STILL BIRTHS ONLY: Completed "Application for Certified Copy of Still Birth Record" (VS 13-E) and $24 fee per copy requested (checked November 7, 2026).
You paid fees to a local registrar or county recorder's office
Fees previously paid to local registrars and county recorder's offices cannot be transferred to CDPH-VR.
Common questions about VS 12
Where do I file it?
Mail completed applications with the fee(s) to: California Department of Public Health Vital Records - MS 5103 P.O. Box 997410 Sacramento, CA 95899-7410.
Sources
[1] Form VS 12 (06/19), Application for Certified Copy of Fetal Death Record, California Department of Public Health (the Official source link on this page).