700-00200 Petition for New, Corrected or Delayed Birth Certificate () Page 1 of 2 STATE OF VERMONT SUPERIOR COURT PROBATE DIVISION Unit Docket No. In re: Name on Certificate Instructions for Filers There are three different ways to change a birth certificate in Vermont. In most cases the original birth certificate is simply corrected. In a few cases, however, either a new birth certificate or a delayed birth certificate needs to be issued. The def initions below will help you determine what type of change you should request. Corrected Birth Certificate: If the date of birth was more than six months ago, any change including correction of a minor error on a birth certificate must be made by filing a petition in the Probate Division requested in all circumstances except those outlined below for new or delayed birth certificates. New Birth Certi ficate: B y law a new birth certificate can be issued in only two circumstances: 1. If the parents of the person who is the subject of the birth certificate were not married at the time erson as his child. 18 V.S.A. 247 5077. 2. If the birth information forms provided by the Department of Health did not permit both parents to be listed as parents because the birth information form required that the parents be of different genders. 18 V.S.A. 2475 077a. Delayed Birth Certificate: A delayed birth certificate should be requested only in cases where a person was born in Vermont and no certificate of birth was filed during the first year following birth. PETITION FOR NEW, CORRECTED OR DELAYED BIRTH CERTIFICATE I am seeking Court approval for the issuance of : ( check one ) A corrected Birth Certificate for myself. A cor rected Birth Certificate for a minor child for whom I am the parent or guardian. A corrected Birth Certificate for an adult other than myself. A new Bi rth Certificate due to marriage of parents subsequent to birth . 18 V.S.A. 2475077 A new birth certificate due to lack of gender - neutral birth information form . 18 V.S.A. 2475077a A Birth C ertificate ( check this box only if no birth certificate is on record ). 1) Information About the Subject of the Petition (i.e. the person for whom a new, corrected or delayed birth certificate nee d s to be issued): a. Date of Birth: Month Day Year b. Location of Birth: Town/City of Birth County VT c. The birth record is on file in the town/city named above: Yes No d.Gender Male Female American LegalNet, Inc. www.FormsWorkFlow.com 700-00200 Petition for New, Corrected or Delayed Birth Certificate () Page 2 of 2 Fill Out this section ONLY if you are asking for a CORRECTED Birth Certificate 2) The birth record contains the following errors and/or omissions: describe errors/omission in detail 3) These errors and/or omissions in the record should be corrected as follows: I therefore request that the Cour t issue a Decree direct ing the Supervisor of the State of V ermont Vital Records Registration to prepare and file a corrected certificate of birth or a new or delayed certificate of birth with the Clerk of the Town/City of , Vermont. Attached are: Filing fee made payable to the Affidavit in Support of Correction of Birth Certificate700-00200ACCertified copy of original Birth Certificate, unless you are requesting a delayed Birth Certificate Additional supporting documentation if required by Court For petitions filed by minors : All of the above documents AND a signed consent form (700 - 00155 ) if parents have consented Date Signature of Petitioner Printed Name American LegalNet, Inc. www.FormsWorkFlow.com