Page 1 is the affidavit and page 2 holds the information and instructions.
Registrant: if the registrant is 18 years or older, the registrant must sign.
Name change: if the registrant is under the age of 18 and the name of the registrant is to be changed, the parent(s) as listed or legal guardian(s) must sign.
Complete: only the upper half of the affidavit.
Record: this affidavit will be linked to the original birth certificate thus becoming part of the birth record.
Alterations: the affidavit is not acceptable if erasures or alterations are made.
| Question | Answer |
|---|---|
| Form Name | DH 430 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 51 |
| Avg. time to fill out | 9 min |
| Edition | Rev 01/2022 |
| Issuing agency | State of Florida Department of Health Bureau of Vital Statistics |
| Where to send | Mail this affidavit with the application (DH 429) and payment to Department of Health Bureau of Vital Statistics, Attn: Correction Unit, P.O. Box 210, Jacksonville, FL 32231-0042 |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | DH 430, DH430, DH Form 430, Form 430, Affidavit of Amendment of Certificate of Live Birth |
| Official source | DH 430 (Rev 01/2022), Florida Department of Health |
Dh Form 430 isn’t the one you’re looking for?