The California VS 12 form is an application used to request a certified copy of a fetal death record from the California Department of Public Health. This form has been in use since July 1, 1905, and is essential for individuals seeking documentation of a fetal death for various personal, legal, or medical reasons.
Any individual who is directly related to the deceased fetus, such as a parent or legal guardian, can apply for a fetal death record. Additionally, representatives of agencies or organizations may also apply on behalf of the family, provided they have the necessary permissions. It is important to ensure that the application is completed accurately to avoid delays in processing.
How much does it cost to obtain a copy of a fetal death record?
The fee for each copy of a fetal death record is $18. This fee must be submitted with the application in the form of a personal check or a postal or bank money order. If the record cannot be found, the fee will not be refunded, as it is retained for the search process. A "Certificate of No Public Record" will be issued in such cases.
To complete the VS 12 form, applicants must provide specific details in the Fetal Death Information section. This includes:
-
First, middle, and last names of the fetus
-
City and county of fetal death (must be in California)
-
Date of fetal death (exact or approximate)
-
Sex of the fetus
-
Names of the parents, including any maiden names
Providing as much accurate information as possible will help in locating the record efficiently.
Once the VS 12 form is completed and signed, it should be mailed to the California Department of Public Health, Vital Records, at the following address:
California Department of Public Health
Vital Records – MS 5103
P.O. Box 997410
Sacramento, CA 95899-7410
Ensure that the payment is included and that cash is not sent, as the department cannot be responsible for lost cash payments.
What should I do if I have questions about the application process?
If you have any questions or need assistance regarding the application process for the VS 12 form, you can contact the California Department of Public Health at (916) 445-2684. They can provide guidance and clarify any uncertainties you may have about the form or the required information.