Certification Of Completion Of Qualifying Premarital Education


This will certify that ________________________________________ and
(Groom’s Name)
_________________________________________________ have completed a course of
(Bride’s Name)
premarital education conducted by the undersigned on
____________________________________________________________ and that
List ALL dates
course qualifies under Section 19-3-30.1 of the Official Code of Georgia Annotated in that it
included at least six hours of instruction involving martial issues (which may include but not
be limited to conflict management, communication skills, financial responsibilities, and extended
family roles) and the couple underwent the course together.
I further certify that I am
_____ A professional counselor, social worker, or marriage and family
therapist who is licensed pursuant to Chapter 10A of Title 43 of the Official Code of Georgia
_____ A psychiatrist who is licensed as a physician pursuant to Chapter 34 of Title 43 of the
Official Code of Georgia.
_____ A psychologist who is licensed pursuant to Chapter 39 of Title 43 of the Official Code of
Georgia Annotated.
_____ An active member of the clergy who:
_____ performed such education in the course of my service as clergy; OR
_____ designated ____________________ to perform such education, and I certify that my
designee is trained and skilled in premarital education, and has certified to me the completion of
the course by the couple.
Sworn to and certified before me
on ___________________, 20___.
Notary Public
Printed Name
City, State, ZIP
(This form is to be completed by the pastor/counselor who performed
the premarital education. The pastor/counselor must sign this form in
the presence of a notary public. The couple should present the
completed form when applying for the marriage license.)


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