Florida Administrative Code
64 - DEPARTMENT OF HEALTH
64V - Vital Statistics
Chapter 64V-1 - VITAL RECORDS AND ASSOCIATED ACTIVITIES
Part IV - AMENDMENT OF DEATH AND FETAL DEATH CERTIFICATES
Section 64V-1.007 - Death and Fetal Death Certificate Amendments; Who May Apply; Fees; Documentary Evidence Requirements

(1) Application to amend items shall be submitted with an Application for Amendment to Florida Death or Fetal Death Record, DH Form 524 (04/16), hereby incorporated by reference and available from the Florida Department of Health, State Office of Vital Statistics, P.O. Box 210, Jacksonville, Florida 32231-0042, and at https://www.flrules.org/Gateway/reference.asp?No=Ref-07199, and except for those items requiring the signature of the attending physician or medical examiner as outlined in subsection (2), of Rule 64V-1.007, F.A.C., shall be accompanied by the amendment fee required in subsection (3), of Rule 64V-1.014, F.A.C.

(2) Amendment of the medical certification of the cause of death section, the date of death, hour or time of death, or the place of death (other than street address) on a death certificate shall be confirmed in writing by the certifying physician or the attending physician as listed on the Florida Certificate of Death, DH 512 (04/16), or by the medical examiner with current jurisdiction of the district in which the death occurred. An Affidavit of Medical Amendment to Florida Certificate of Death, DH Form 434A (04/16), hereby incorporated by reference and available from the Florida Department of Health, State Office of Vital Statistics, P.O. Box 210, Jacksonville, Florida 32231-0042, and at https://www.flrules.org/Gateway/reference.asp?No=Ref-07193, shall be completed and signed before a notarizing official by the certifying physician or the attending physician as listed on the Florida Certificate of Death, DH Form 512 (04/16), or by the medical examiner with current jurisdiction of the district in which the death occurred. Such affidavit shall be attached to the original death certificate. Amendment fees required pursuant to paragraph (1)(c), of Section 382.0255, F.S., are waived in such cases.

(3) Amendment of the following items on a death certificate shall be made on an Affidavit of Amendment to a Florida Certificate of Death, DH Form 433 (04/16), hereby incorporated by reference and available from the department, and at https://www.flrules.org/Gateway/reference.asp?No=Ref-07181. Such affidavit shall be signed before a notarizing official by the informant or next of kin and the funeral director except where such signature has been waived by the department, pursuant to subsection (4), of Rule 64V-1.007, F.A.C., and shall require the birth certificate of the decedent or two documents as referenced in subsection (6), of Rule 64V-1.007, F.A.C., which were established by the decedent. Documents submitted must be original, certified, or notarized copies and must substantiate the facts to be amended and contain the date the document was originally established:

(4) The department may waive the signature of the funeral director as required in subsection (3), of Rule 64V-1.007, F.A.C., in cases where the death occurred more than a year prior to the request for amendment.

(5) The department may not alter the surviving spouse item other than those items in paragraph (3)(f), of Rule 64V-1.007, F.A.C., except on order of a court of competent jurisdiction.

(6) Suggested sources of evidence submitted in support of the amendment are as follows:

(7) Other records which are verifiable may be substituted. Information contained in documents may be combined if they interconnect all the facts required.

(8) Amendment of any item on a fetal death certificate shall be made on an Affidavit of Amendment to a Florida Certificate of Fetal Death, DH Form 433A (04/16), hereby incorporated by reference and available from the Florida Department of Health, State Office of Vital Statistics, P.O. Box 210, Jacksonville, Florida 32231-0042, and at https://www.flrules.org/Gateway/reference.asp?No=Ref-07182. Such affidavit shall be signed before a notarizing official by a parent listed on the Florida Certificate of Fetal Death, DH Form 428 (04/16), previously incorporated by reference in Rule 64V-1.0061, F.A.C., except in the case where a father's name is to be added to the Florida Certificate of Fetal Death. In this case, the notarized signatures of both parents shall be required.

(9) If amendment of the medical certification of the cause of death section or the date of death, hour or time of fetal death or the place of fetal death other than street address on a fetal death certificate is to be amended, in addition to the Affidavit of Amendment to a Florida Certificate of Fetal Death, DH Form 433A (04/16), the amendment shall be confirmed in writing by the attending physician or medical examiner with current jurisdiction of the district in which the fetal death occurred.