The California VS 12 form is an official application used to request certified copies of fetal death records from the California Department of Public Health. This form is essential for individuals seeking documentation related to fetal deaths that have been recorded since July 1, 1905. Understanding how to properly complete this form can ensure that you receive the necessary records in a timely manner.
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The California VS 12 form is a crucial document for those seeking certified copies of fetal death records in the state. These records have been maintained by the California Department of Public Health since July 1, 1905. To obtain a copy, individuals must fill out a separate application for each record they wish to request. The form requires detailed information about the fetal death, including the names of the parents and the date and location of the event. It is important to provide accurate information; otherwise, the department may be unable to locate the record. There is a fee of $18 for each copy requested, which must be submitted via check or money order. If no record is found, the fee will not be refunded, but a "Certificate of No Public Record" will be issued. Applicants should take care to avoid sending cash, as the department cannot be responsible for lost payments. Once completed, the application should be mailed to the California Department of Public Health's Vital Records office in Sacramento.
State of California – Health and Human Services Agency
California Department of Public Health
APPLICATION FOR CERTIFIED COPY OF FETAL DEATH RECORD
INFORMATION:
Fetal death records have been maintained in the California Department of Public Health Vital Records since July 1, 1905.
INSTRUCTIONS:
1.Complete a separate application for each fetal death record requested.
2.Complete the Applicant Information section and provide your signature where indicated. In the Fetal Death Information section, provide all the information you have available to identify the fetal death record. If the information you furnish is incomplete or inaccurate, we may not be able to locate the record.
3.Submit $18 for each copy requested. If no fetal death record is found, the fee will be retained for searching the record (as required
by law) and a “Certificate of No Public Record” will be issued to the applicant. Indicate the number of copies you want and include the correct fee(s) in the form of a personal check or postal or bank money order (International Money Order for out‐of‐country requests) made payable to CDPH Vital Records. PLEASE SUBMIT CHECK OR MONEY ORDER ̶ DO NOT SEND CASH (CDPH cannot be held responsible for fees paid in cash that are lost, misdirected, or undelivered).
4.Mail completed applications with the fee(s) to:
Vital Records ̶ MS 5103
P.O. Box 997410
Sacramento, CA 95899‐7410
(916) 445‐2684
Fee: $18 per copy (payable to CDPH Vital Records). PLEASE SUBMIT CHECK OR MONEY ORDER ̶ DO NOT SEND CASH
(CDPH cannot be held responsible for fees paid in cash that are lost, misdirected, or undelivered).
PLEASE ATTACH CHECK HERE
APPLICANT INFORMATION (PLEASE PRINT OR TYPE)
Today’s Date:
Agency Name (if applicable)
Agency Case Number
Inmate ID Number
Print Name of Applicant
Signature of Applicant
Purpose of Request
Mailing Address – Number, Street
Amount Enclosed – DO NOT SEND CASH
Number of Copies
$ ______ Check $_____ Money Order
City
State/Province
ZIP Code
Daytime Telephone (include area code)
Country
(
)
Name of Person Receiving Copies, if Different from Applicant
Mailing Address for Copies, if Different from Applicant
State
FETAL DEATH INFORMATION (PLEASE PRINT OR TYPE)
Complete information below as shown on the fetal death record, to the best of your knowledge.
FETAL DEATH FIRST Name
MIDDLE Name
LAST Name
City of Fetal Death (must be in California)
County of Fetal Death
Date of Fetal Death – MM/DD/CCYY (If unknown, enter approximate date of fetal death)
Sex
_____Female _____Male
Father/Parent FIRST Name
LAST Name (Before Marriage/Domestic Partnership)
Mother/Parent FIRST Name
FETAL DEATH
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VS 12 (01/14)
Filling out the California VS 12 form requires careful attention to detail. Each section must be completed accurately to ensure the request for a fetal death record is processed smoothly. Follow these steps to fill out the form correctly.
The California VS 12 form is an application used to request a certified copy of a fetal death record. This form is managed by the California Department of Public Health and has been in use since July 1, 1905. It allows individuals to obtain official documentation related to fetal deaths that occurred in California.
Anyone can apply for a fetal death record, but the applicant must provide accurate information to help locate the record. This could be a parent, guardian, or any individual with a legitimate interest in obtaining the record. It’s important to fill out the form completely to ensure the best chance of finding the record.
You will need to fill out two main sections: the Applicant Information and the Fetal Death Information. Here’s what to include:
Providing as much detail as possible will help in locating the record.
The fee for each copy of a fetal death record is $18. This fee must be submitted with your application in the form of a personal check or a money order. If no record is found, the fee will not be refunded, but you will receive a “Certificate of No Public Record.”
Complete the application form and mail it along with your payment to the following address:
California Department of Public Health Vital Records – MS 5103 P.O. Box 997410 Sacramento, CA 95899-7410
Be sure to include your check or money order, and remember, do not send cash.
If the record cannot be located, the California Department of Public Health will issue a “Certificate of No Public Record.” This document confirms that a search was conducted, but no record was found. The search fee will still be retained as required by law.
Yes, you can request multiple copies of the same fetal death record. Just indicate the number of copies you want on the application form and include the corresponding fees for each copy.
Yes, the application must be filled out clearly and accurately. Use printed or typed letters. Ensure that all required fields are completed, and double-check for any mistakes before submitting. Incomplete or inaccurate applications may delay the process or prevent the record from being located.
If you have further questions or need assistance, you can contact the California Department of Public Health at (916) 445-2684. They can provide guidance on the application process and any other inquiries you may have.
Submitting Incomplete Information: One of the most common mistakes is failing to provide all the necessary details in the Fetal Death Information section. If any information is missing or incorrect, it may hinder the ability to locate the record.
Not Using a Separate Application: Applicants sometimes attempt to request multiple fetal death records on a single application form. Each record requires a separate application, and combining requests can lead to delays or rejections.
Incorrect Payment Amount: It's essential to include the correct fee of $18 for each copy requested. Failing to do so can result in the application being returned or delayed. Always double-check the total amount enclosed.
Sending Cash: Many applicants mistakenly send cash instead of a check or money order. The California Department of Public Health explicitly states that cash should not be sent, as they cannot be responsible for lost or misdirected cash payments.
Ignoring Signature Requirements: The application requires the applicant’s signature. Omitting this important step can result in the application being deemed invalid, causing unnecessary delays.
Not Providing Accurate Contact Information: It’s crucial to ensure that the mailing address and daytime telephone number are correct. Providing inaccurate contact details may prevent the department from reaching you if there are issues with your application.
The California VS 12 form is essential for requesting certified copies of fetal death records. However, there are several other forms and documents that may be needed in conjunction with this application. Understanding these forms can help streamline the process and ensure that all necessary information is submitted correctly. Below is a list of commonly used forms alongside the California VS 12.
By being aware of these forms, you can navigate the process of obtaining fetal death records and related documents more effectively. Each form serves a specific purpose and can help ensure that all necessary information is collected and submitted correctly. Taking the time to gather the right documentation can make a significant difference in the overall experience.
The California VS 12 form is similar to the Application for Certified Copy of Birth Record. Both documents are used to request vital records from the California Department of Public Health. The application process requires the requester to provide personal information, including their name and contact details, as well as specific details about the individual whose record is being requested. Each application must be accompanied by a fee, which is retained if the record cannot be located. Both forms emphasize the importance of accurate information to ensure successful retrieval of the requested records.
Another document comparable to the California VS 12 form is the Application for Certified Copy of Death Record. This form serves a similar purpose in obtaining vital records, specifically related to deceased individuals. Like the VS 12, it requires the applicant to fill out their personal information and provide details about the deceased. The fee structure is also similar, with a set amount charged for each copy requested. Both forms stress the necessity of providing complete and accurate information to facilitate the search for the record.
The Application for Certified Copy of Marriage Record also shares similarities with the California VS 12 form. This document is used to obtain records of marriages that have taken place in California. The application process is alike, requiring personal details from the requester and information about the marriage. A fee is required for each copy requested, and both forms highlight the importance of accuracy in the information provided to ensure successful retrieval of records.
Another related document is the Application for Certified Copy of Divorce Record. This form is utilized to request records pertaining to finalized divorces within California. Similar to the VS 12 form, it requires the applicant to submit their information along with details about the divorce. The fee structure mirrors that of the other vital record applications, reinforcing the need for precise information to locate the requested record effectively.
The Application for Certified Copy of Adoption Record is another document that aligns with the California VS 12 form. This application is used to obtain records related to adoptions finalized in California. Both forms require the applicant to provide personal details and specific information about the record being requested. The fee for obtaining copies is consistent with other vital records applications, and both documents stress the importance of complete and accurate information to ensure the success of the request.
The Application for Certified Copy of Domestic Partnership Record is also similar to the California VS 12 form. This document allows individuals to request records related to registered domestic partnerships in California. As with the VS 12, the applicant must provide their information and details about the partnership. The fee structure remains the same, and both forms highlight the necessity of accurate information for successful record retrieval.
Lastly, the Application for Certified Copy of Paternity Record bears resemblance to the California VS 12 form. This application is used to obtain records that establish paternity in California. The process is similar, requiring the applicant's personal information and details about the paternity case. Each request involves a fee, reinforcing the need for accuracy in the information provided to facilitate the search for the record.
When filling out the California Vs 12 form, there are important steps to follow to ensure your application is processed smoothly. Here’s a list of things you should and shouldn’t do:
Misconceptions about the California VS 12 form can lead to confusion when requesting fetal death records. Below are five common misconceptions along with clarifications.
Filling out the California Vs 12 form for obtaining a certified copy of a fetal death record can seem daunting. Here are some key takeaways to help simplify the process:
By keeping these points in mind, you can navigate the application process more smoothly. Make sure to double-check all information before submitting your application to avoid delays.