Petition to Amend Birth Certificate - Georgia (United States)

The Georgia Superior Courts has released this version of the "Petition to Amend Birth Certificate" on February 1, 0008.

This form may be used by all Georgia residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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SUPERIOR COURT OF GWINNETT COUNTY
STATE OF GEORGIA
IN RE:
,
Civil Action
a minor child, born ________________
Case Number ______________________
,
Petitioner.
PETITION TO AMEND BIRTH CERTIFICATE
The Petitioner, ______________________________, petitions the Court on behalf
of his/her minor child, ______________________________, to enter an Order to amend
the birth certificate of the minor child. In support of this petition, the Petitioner states
the following:
1.
The Petitioner resides in Gwinnett County, Georgia. Therefore, jurisdiction and
venue are proper in this Court.
2.
The minor child resides with the Petitioner in Gwinnett County.
3.
The Petitioner is the G mother G father of the minor child and his/her name
appears on the minor child’s birth certificate.
4.
This petition is being served upon the State Registrar of Vital Records, Georgia
Department of Human Resources, in Atlanta, Georgia.
_____________________________________________________________________________________
Petition to Amend Birth Certificate
-
Rev. February 2008
Page 1 of 4
Provided by the Gwinnett Family Law Clinic
SUPERIOR COURT OF GWINNETT COUNTY
STATE OF GEORGIA
IN RE:
,
Civil Action
a minor child, born ________________
Case Number ______________________
,
Petitioner.
PETITION TO AMEND BIRTH CERTIFICATE
The Petitioner, ______________________________, petitions the Court on behalf
of his/her minor child, ______________________________, to enter an Order to amend
the birth certificate of the minor child. In support of this petition, the Petitioner states
the following:
1.
The Petitioner resides in Gwinnett County, Georgia. Therefore, jurisdiction and
venue are proper in this Court.
2.
The minor child resides with the Petitioner in Gwinnett County.
3.
The Petitioner is the G mother G father of the minor child and his/her name
appears on the minor child’s birth certificate.
4.
This petition is being served upon the State Registrar of Vital Records, Georgia
Department of Human Resources, in Atlanta, Georgia.
_____________________________________________________________________________________
Petition to Amend Birth Certificate
-
Rev. February 2008
Page 1 of 4
Provided by the Gwinnett Family Law Clinic
5.
The Petitioner requests that this Court enter an Order to amend the birth certificate
because the Department of Vital Records has informed the Petitioner that the information
on the minor child’s birth certificate cannot be amended without a court order.
6.
The Petitioner is submitting the following documents with her petition to support
the facts alleged in the petition: ______________________________________________
_______________________________________________________________________.
7.
The Petitioner requests that the birth certificate be amended as follows:
G (a) Child's Name:
G Child’s First Name which currently reads:________________________ should
read: _______________________________.
G Child’s Middle Name which currently reads:_______________________ should
read: _______________________________.
G Child’s Last Name which currently reads:________________________ should
read: _______________________________.
G (b) Father's Name
G Father’s First Name which currently reads:________________________ should
read: _______________________________.
G Father’s Middle Name which currently reads:_______________________ should
read: _______________________________.
G Father’s Last Name which currently reads:________________________ should
read: _______________________________.
G (c) Mother's Name
G Mother’s First Name which currently reads:________________________ should
read: _______________________________.
_____________________________________________________________________________________
Petition to Amend Birth Certificate
-
Rev. February 2008
Page 2 of 4
Provided by the Gwinnett Family Law Clinic
G Mother’s Middle Name which currently reads:_______________________
should read: _______________________________.
G Mother’s Last Name which currently reads:________________________ should
read: _______________________________.
G (d) Other error described here: ______________________________________________
should read: _________________________________________________________.
8.
The Petitioner is submitting affidavits with this petition explaining how and why
the birth certificate should be amended.
9.
The Petitioner in seeking to amend the minor child’s birth certificate is not
attempting to defraud anyone.
WHEREFORE, the Petitioner respectfully requests that this Court enter an order
directing Vital Records to amend the minor child’s birth certificate.
Dated: ____________________
______________________________________
Petitioner, Pro se (Signature)
Name: ________________________________
Address: ______________________________
______________________________
Phone:
______________________________
_____________________________________________________________________________________
Petition to Amend Birth Certificate
-
Rev. February 2008
Page 3 of 4
Provided by the Gwinnett Family Law Clinic
SUPERIOR COURT OF GWINNETT COUNTY
STATE OF GEORGIA
IN RE:
,
Civil Action
a minor child, born ________________
Case Number ______________________
,
Petitioner.
VERIFICATION
PERSONALLY APPEARED BEFORE ME, the undersigned officer authorized to
administer oaths, ______________________________ who after having been duly
sworn, on oath depose and states that the facts contained in the foregoing PETITION TO
AMEND BIRTH CERTIFICATE are true and correct.
________________________________
Petitioner (Signature)
Sworn to and subscribed before me
This ______ day of
______________, 200____.
_____________________________
Notary public
My Commission Expires
____________________.
_____________________________________________________________________________________
Petition to Amend Birth Certificate
-
Rev. February 2008
Page 4 of 4
Provided by the Gwinnett Family Law Clinic

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