Complete a separate application for each fetal death record requested.
Applicant: complete the Applicant Information section and provide your signature where indicated.
Fetal Death Information: provide all the information you have available to identify the fetal death record.
City of Fetal Death: must be in California.
CNPR: if you require documentation that a fetal death record does not exist, check the box for CNPR (Certificate of No Public Record) Request.
Check or money order: please submit check or money order, do not send cash.
| Question | Answer |
|---|---|
| Form Name | Form VS 12 |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 36 |
| Avg. time to fill out | 6 min |
| Edition | Rev 06/19 |
| Issuing agency | California Department of Public Health |
| Where to send | California Department of Public Health Vital Records, MS 5103, P.O. Box 997410, Sacramento, CA 95899-7410 |
| Other names | VS 12, VS12, Form VS 12, California VS 12, Application for Certified Copy of Fetal Death Record, California fetal death certificate |
| Official source | Form VS 12 (Rev 06/19), California Department of Public Health |
California Form Vs 12 isn’t the one you’re looking for?