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    DCH 0848 CHGBX

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    Shaggy Shag
    This document is an application to add a father's name to a Michigan birth certificate. It requests information to identify the applicant and child, as well as the mother and father to be added. The applicant must submit valid identification, documents proving paternity such as an affidavit of parentage or court order, and pay a $50 application fee plus $16 for each additional certified copy. The application notes it can take 5-6 weeks to process if all required documentation is received. Any false applications may result in fines or imprisonment.

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    © All Rights Reserved
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    DCH 0848 CHGBX

    Uploaded by

    Shaggy Shag
    55 views2 pages
    This document is an application to add a father's name to a Michigan birth certificate. It requests information to identify the applicant and child, as well as the mother and father to be added. The applicant must submit valid identification, documents proving paternity such as an affidavit of parentage or court order, and pay a $50 application fee plus $16 for each additional certified copy. The application notes it can take 5-6 weeks to process if all required documentation is received. Any false applications may result in fines or imprisonment.

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    DCH-0848-CHGBX

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    This document is an application to add a father's name to a Michigan birth certificate. It requests information to identify the applicant and child, as well as the mother and father to be added. The applicant must submit valid identification, documents proving paternity such as an affidavit of parentage or court order, and pay a $50 application fee plus $16 for each additional certified copy. The application notes it can take 5-6 weeks to process if all required documentation is received. Any false applications may result in fines or imprisonment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    55 views2 pages

    DCH 0848 CHGBX

    Uploaded by

    Shaggy Shag
    This document is an application to add a father's name to a Michigan birth certificate. It requests information to identify the applicant and child, as well as the mother and father to be added. The applicant must submit valid identification, documents proving paternity such as an affidavit of parentage or court order, and pay a $50 application fee plus $16 for each additional certified copy. The application notes it can take 5-6 weeks to process if all required documentation is received. Any false applications may result in fines or imprisonment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    Mail Application and Fee to: Michigan Department of Health

    Vital Records Changes and Human Services


    P.O. Box 30721
    www.michigan.gov/vitalrecords
    Lansing, MI 48909

    APPLICATION TO ADD A FATHER ON A MICHIGAN BIRTH RECORD


    If any information is unknown, please indicate “unknown”. Incomplete applications will be returned.
    PART 1 - APPLICANT INFORMATION Copy of valid Identification required

    Name:
    (First) (Middle) (Last)

    Address: City/State: Zip:

    Phone: E-mail:
    PART 2 - ELIGIBILITY (See next page for details)
    Self (Correcting my own record) Legal guardian of the person named on the record
    Parent of the child Legally licensed representative of the person named on the record
    PART 3 - CHILD’S INFORMATION NEEDED TO LOCATE CURRENT BIRTH CERTIFICATE
    Full Name on Birth Certificate: Date of Birth:

    Do you want to change the child’s name? Yes No


    New Name:
    (First) (Middle) (Last)

    Place of Birth: Gender: Male Female X


    (City and County)
    PART 4 - MOTHER’S INFORMATION
    Mother’s Full Name Before Married: Mother’s Date of Birth:

    Do you want to change the mother's current name after marrying the father? Yes No (Copy of marriage required)

    (First) (Middle) (Last)


    PART 5 - FATHER’S INFORMATION TO BE ADDED
    Father’s Full Name:

    (First) (Middle) (Last)


    Father’s State of Birth: Father’s Date of Birth:
    (Country if not U.S.)

    Father’s Social Security Number:


    PART 6 - SIGNATURE(S) REQUIRED TO PROCESS
    APPLICATION
    **If ,
    changing a minor’s name, all parents listed on the record must sign. If the child is over the age of 15 and the name change
    is not court ordered, we also require the child’s signature.

    Signature of Person Requesting Change: Date:

    __________________________________________________________________________________________________
    Other Signature: Date:
    __________________________________________________________________________________________________
    Other Signature: Date:

    _________________________________________________________________________________________________
    REQUIRED DOCUMENTATION
    Please check the box for the documentation you are submitting now or have already submitted to our office.
    □ An original signed/notarized Affidavit of Parentage is attached with the application.
    □ A court order is attached (Order of filiation or court determination of paternity)
    □ Affidavit of Parentage has already been duly signed, notarized, and submitted to the Central Paternity Registry.

    □ A Paternity Acknowledgment that was filed before June 1, 1997. A true or certified copy from the probate court must be
    attached.
    The Affidavit of Parentage form can be printed out from our website at www.michigan.gov/vitalrecords
    or call 517-335-8666 to have one mailed to you.
    PAYMENT Check or Money Order made out to the “State of Michigan” Application Fee is Non-Refundable

    Application Fee: $50.00 (includes one copy) $50.00


    Additional Certified Copies: $16.00 each $
    RUSH Processing Fee: $25.00 $
    TOTAL ENCLOSED: $

    ELIGIBILITY
    If you are the child listed on the record, you must be at least 18 years old or legally emancipated. 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 attorney and client’s identification.
    IDENTIFICATION REQUIREMENT Original documents will not be returned to you
    To change a Michigan birth record, a copy of a current valid, government-issued identification is required to establish
    eligibility.

    If you are changing a child's name, we require identification for all parents listed on the record. If a child's name change is
    court ordered, we only require identification for one parent.
    Please send a copy of one of the following unexpired identifications:
     U.S. or U.S. Territories Driver’s License or Identification Card
     U.S. or Foreign Passport
     U.S. Passport 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.
    If you do not have identification as listed above, we will accept other documents to prove your identity. For a list of
    alternative documents please visit our website at www.michigan.gov/vitalrecords or call our office at 517-335-8666.
    PROCESSING TIME Prepaid self-addressed envelopes will NOT be used by our office
    Normal processing time to correct or change a Michigan birth certificate is 5-6 weeks if all required documents are
    received. If we must contact you for additional documentation, the processing time starts when we receive everything
    needed. If you pay for RUSH service, processing time is 2-3 weeks from when everything is received. Processing time is
    not guaranteed. There could be situations out of our control that cause processing times to be longer.
    Note: Applications sent to the Vital Records post office box with an overnight delivery are not received in the Vital Records
    office for three (3) days.
    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).
    ___________________________________________________________________________________________________________

    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.

    DCH-0848-CHGBX Rev 05-2023 MCL 333.2824(4), 333.2872(1) and 333.2891(9)

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