LOUISIANA DEPARTMENT OF HEALTH

BIRTH RECORD NAME CORRECTION

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ABOUT THE FORM

This affidavit supports a qualifying correction to a Louisiana birth record. It is not a general court-ordered name change and must be submitted with the records and evidence Vital Records requires.

OFFICIAL FORM DETAILS

Issuing agency
Louisiana Department of Health
Notarization status
Follow the affidavit's current notarization block

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