Form VS 44 at a glance
What it is: Form VS 44 is the Court Report of Adoption of the State of California Department of Public Health, Vital Records, with no erasures, whiteouts, photocopies, or alterations.
Where and when to file: In Part III, the court clerk must obtain as much information as is available to complete Part I and II before completing Part III and forwarding the report and Court Order/Final Decree to the State Registrar as required by law.
Adoptive parents must furnish personal information about themselves as it was on the child's date of birth. This information is used to prepare the new Certificate of Birth.
A filled-in Form VS 44 example: an adoption report with a new certificate
How to fill out Form VS 44, box by box
Part I, the child's name
Type or Print Clearly in Black Ink Only. In Part I, the information provided in this section must be the information as it was at birth. Without this information, it may be impossible to prepare a new Certificate of Birth.
Enter the Name of Child in 1A First, 1B Middle and 1C Last (Birth).
Facts of Birth
Enter 2. Sex, 3. Date of Birth as MM/DD/CCYY and 4. Name of Physician, Attendant, or Certifier.
Enter the Place of Birth: 5A Name of Hospital or Facility, 5B City and 5C State/Country.
Parents' Data
Enter 6A First, 6B Middle and 6C Last (Birth) and 7A First, 7B Middle and 7C Last (Birth) of the Full Name of Parent, then mark the Relationship: Mother, Father or Parent.
Parent Information
Enter the Name of Parent in 8A First, 8B Middle, 8C Last (Current) and 8D Last (Birth), then 9. State/Country of Birth and 10. Date of Birth as MM/DD/CCYY.
Enter the Name of Parent in 11A First, 11B Middle, 11C Last (Current) and 11D Last (Birth), then 12. State/Country of Birth and 13. Date of Birth as MM/DD/CCYY.
Check the Appropriate Box, Adoptive Parent or Biological Parent, and mark the Relationship: Mother, Father or Parent.
14. Please check one, the original birth certificate sealed
14. Please check one. I want the original birth certificate sealed, and a new birth certificate established.
I choose not to have a new birth certificate established, pursuant to Health and Safety Code Section 102640.
15. The name and address of the hospital omitted
15. Do you want the name and address of the hospital or other facility where the birth occurred omitted from the new birth certificate as provided for in Health and Safety Code Section 102645? Please check one: Yes or No.
Verification of Part II
For the Verification of Part II, enter 16. Signature of Parent Verifying Part II and 17. Mailing Address of Parent Verifying Part II.
Agency or Department
Agency or Department: enter 18A. Name of Agency/Department and 18B. Mailing Address of Agency/Department that Assisted in the Adoption.
Attorney
Attorney: enter 19A. Name of Attorney, 19B. Signature of Attorney and 19C. Mailing Address of Attorney that Assisted in the Adoption.
Part III, the court clerk
The court clerk certifies the adoption date and the case number of the decree of adoption, and enters 21A New Name Per Adoption First, 21B Middle and 21C Last.
The court clerk enters 22A. Signature and Seal of Court Clerk, By, 23. Clerk in and for the County of, 24. Date Signed as MM/DD/CCYY and 25. Adoption Petition Filed as MM/DD/CCYY.
Recipient's
Recipient's: enter Name, Email Address, Name and Mailing Address, Address (Street and Number), City, State, Zip code and Daytime Phone Number.
Sources
[1] Form VS 44 (Rev. 05/26), Court Report of Adoption, State of California Department of Public Health, Vital Records (the Official source link on this page).