Michigan Application Birth Form PDF Details

The Michigan Application to Correct or Change a Michigan Birth Record is a critical tool provided by the Michigan Department of Health and Human Services. Designed for individuals seeking to amend details on a birth certificate, this document encompasses a variety of adjustments ranging from minor corrections for those under one year old to more substantial changes such as legal name modifications and adjustments in parental information post-birth. To initiate this process, applicants must provide clear and legible personal information, select their eligibility category which includes the person named on the record, a parent named on the record, or a legal guardian, and specify the type of amendment needed. Stringent documentation requirements are in place to support the requested changes, including photo identification to guard against identity theft, and various pieces of documentary evidence depending on the nature of the correction or change. The application outlines a fee structure, with a standard fee covering the amendment request and the issuance of one certified copy of the updated record. Processing times can vary, but expedited services are available for an additional fee. The importance of filling this application accurately cannot be overstressed, as it involves legal penalties for knowingly providing false information. Furthermore, the Michigan Department of Health and Human Services emphasizes its commitment to non-discrimination in providing its services.

QuestionAnswer
Form NameMichigan Application Birth Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesapplication for a certified copy of michigan birth records, mi application birth record form, to change birth, michigan application birth

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APPLICATION TO CORRECT OR CHANGE A MICHIGAN BIRTH RECORD

Michigan Department of Health and Human Services

 

For additional information:

 

 

MAIL APPLICATION AND PROPER FEE TO:

 

517-335-8660

 

 

Vital Records Changes

 

www.Michigan.gov/VitalRecords

 

 

P.O. Box 30721

 

 

 

 

Lansing MI 48909

 

APPLICANT (PERSON REQUESTING CHANGE OR CORRECTION)

PLEASE PRINT CLEARLY AND LEGIBLY

 

Applicant's

 

 

 

 

Name:

 

 

 

 

Address:

 

 

 

 

(Cannot send to General Delivery)

 

City/State:

Zip:

 

Daytime Phone Required: (

)

Notifications by email? Yes No

 

 

 

Email Address:

To protect from identity theft, PHOTO IDENTIFICATION must be presented along with this application. (See back for details)

ELIGIBILITY (Please check which category makes you eligible to request this change or correction)

To be eligible to correct or change a birth record, you must be the person named on the record and at least 18 years old, a parent named on the record, or a court-appointed legal guardian or legally licensed representative of the person named on the record. Legal guardians must include a

copy of the court guardianship documents. Legally licensed representatives must provide information on official letterhead, documenting that he/she represents

the person named on the record and provide their state bar license number, along with client’s identification.

 

Person named on the record

Legal guardian of the person named on the record

 

(Must be at least 18 years old or legally emancipated)

Legally licensed representative of the person named on the record

 

Parent named on the record

 

TYPE OF CHANGE OR CORRECTION REQUESTED

(Please indicate below which type of change or correction you are requesting)

 

 

 

 

Correct birth record information for a person under the age of 1 (one)

Correct birth record information for a person age 1-5 (one to five)

Correct birth record information for a person over the age of 6 (six)

Court-ordered legal name change (court order required)

Name change for parents who have married after the birth (marriage record required)

Remove a person who is not the biological parent/father (court order required)

There is a separate application if you need to add a parent/father’s name to a birth record when there is no parent/father currently named on the record.

 

 

INFORMATION NEEDED TO LOCATE BIRTH RECORD TO BE CHANGED

_ ___

___________

 

 

 

If any birth information is unknown, please indicate unknown

 

STATE FILE NUMBER (If known)

 

 

NAME

 

 

 

 

 

GENDER

DATE OF BIRTH

 

 

AT

First

 

Middle

 

Last

Male

 

(mm/dd/yyyy)

 

 

BIRTH

 

 

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF THE PERSON ON RECORD IS ADOPTED OR HAS HAD

Adoption

 

 

 

 

 

 

 

A LEGAL NAME CHANGE (OTHER THAN MARRIAGE)

Legal Name

 

 

 

 

 

 

 

PLEASE INDICATE THAT NAME HERE

 

Change

First

Middle

 

Last

 

 

PLACE OF

 

 

 

 

 

 

 

 

 

 

BIRTH

 

Hospital

 

 

City

 

County

 

 

 

 

PARENT/MOTHER'S

 

 

 

PARENT/FATHER'S

 

 

 

 

 

 

NAME BEFORE

 

 

 

NAME BEFORE

 

 

 

 

 

 

FIRST MARRIED

First

Middle

Last

FIRST MARRIED

First

Middle

Last

 

 

 

 

SEE BACK FOR CURRENT FEES, PHOTO ID

REQUIREMENTS AND PROCESSING TIMES

 

 

 

 

 

CHANGES REQUESTED: ITEM IN ERROR

 

INFORMATION AS IT SHOULD APPEAR

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE(S) REQUIRED TO PROCESS APPLICATION. When two parents are named on the record, both parents’ signatures and current, valid photo identification are required to correct, add or change a child’s name, unless a court order of legal name change is supplied.

Signature of Person

 

Requesting Change

Date

 

 

Other Signature

Date

 

 

REQUIRED DOCUMENTATION

Changes or corrections to birth records that can be made by this office are limited by law and are subject to very specific supporting documentation. In general, you must include with this application, at least two (2) pieces of dated documentary evidence. To change any part of the name requires two documents dated close to the time of birth. (Exception: Only one document dated five years ago is required to correct the spelling of the first or middle name of the person named on the record). If you are requesting that the name on the record be changed due to a legal name change, only the court order is needed for documentation. If you need more information or have questions, you may call our Changes Unit direct at 517-335-8660.

PAYMENT - The fee for correcting or changing a Michigan birth record is $50.00 and includes one copy of the record with the changes made. Additional copies of the new record are available for $16.00 each when ordered at the same time. Payment must be by check or money order and made payable to the "State of Michigan."

PROCESSING TIME – Normal processing time for all changes or corrections will be 5-6 weeks from the date all documentation, payments and photo ID are received in the State Vital Records Office. Two-three week rush processing is available for an additional fee.

Application Fee

$50.00

$ 50.00

(Non-Refundable)

 

 

Fee includes one (1) certified copy of

 

 

the record

 

 

________ Additional Certified Copies

$16.00 Each

$

Rush Fee

$25.00

$

 

 

 

TOTAL ENCLOSED

 

$

 

 

 

PENALTIES: Any person who willfully and knowingly makes false application to change a Michigan birth record may be fined and/or imprisoned pursuant to MCL 333.2894(1)(b) and (c).

For Accounting Use Only

The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or

expression, political beliefs or disability.

Note: Applications sent to the Vital Records post office box with an

overnight delivery are not received in Vital Records for three (3) days.

DCH-0847-CHGBX Rev 8-2021 MCL 333.2871(1) and 333.2891(10)

PHOTO ID REQUIREMENTS FOR CHANGING OR CORRECTING

A MICHIGAN BIRTH RECORD

*Please Send Photocopies – Not Original Documents*

Under Michigan law, birth records are restricted documents. To request a birth record, a current valid, government issued identification is required to establish eligibility (except for an unrestricted birth record that is at least 100 years old). To protect from identity theft, a copy of the applicant’s government issued identification must be presented along with the application and fees.

Tier 1 Documentation that establishes identity by itself.

U.S. or Foreign Passport

U.S. Passport Card

U.S. or U.S. Territories Driver’s License or Identification Card

U.S. Military Identification Card with both picture and signature

Other U.S. or U.S. Territories issued document that meets the following criteria: Document must be unexpired. Document must contain a photograph and at least the following information: name, date of birth, date of expiration, signature, and address.

--OR (If you do not have a document from Tier 1)

Tier 2 Documentation must include all documentation in one of the categories below:

Any of the documents in Tier 1 that expired within the past 5 years and any one document from Tier 3 issued within the past year.

Employment identification with photo, accompanied with a pay stub or W-2 form issued within the past year.

Student identification with photo, accompanied by a current report card or other proof of current school enrollment. Both documents must be for the same institution.

Department of Corrections identification card accompanied by probation or discharge papers issued within the past year.

If an inmate is currently incarcerated, a Department of Corrections identification card, accompanied by a verification of incarceration issued within the past year.

--OR (If you do not have documents from Tier 1 or 2)

Tier 3 Documentation must include at least three alternative documents of different types from the list below, one must have been issued within the past year:

Any of the documents in Tier 1 expired more than 5 years.

Social Security Card (must be signed)

Marriage or Divorce certificate

Your child’s birth certificate

IRS form W-2

Paycheck stub

Bank statement

Voter registration

Motor vehicle registration

Health insurance card

Utility Bill

Doctor/hospital/dentist bill

Religious/community organization documents, baptismal certificate

Military DD-214 discharge paper or equivalent

School records

Letter/benefit statement from a government agency, like SSA or

IRS

Land or rental agreement

Military ID with either a picture or signature.

Other documents that establish identity to a degree equivalent to those listed above.

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Stage number 1 for completing mi application birth record form

2. When the previous section is finished, you're ready insert the needed details in ELIGIBILITY Please check which, INFORMATION NEEDED TO LOCATE BIRTH, PARENTFATHERS NAME BEFORE FIRST, GENDER Male Female, Legal Name, DATE OF BIRTH mmddyyyy, SEE BACK FOR CURRENT FEES PHOTO ID, CHANGES REQUESTED ITEM IN ERROR, INFORMATION AS IT SHOULD APPEAR, and SIGNATURES REQUIRED TO PROCESS in order to go further.

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Any of the documents in Tier, Land or rental agreement, and Each inside mi application birth record form

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