Guardianship Petition Application Page 6

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CONSENT FORM
I HEREBY AUTHORIZE THE BARROW COUNTY PROBATE JUDGE, TAMMY S. BROWN, TO
RECEIVE ANY CRIMINAL HISTORY RECORD INFORMATION PERTAINING TO ME, WHICH
MAY BE IN THE FILES OF ANY STATE OR LOCAL CRIMINAL JUSTICE AGENCY IN GEORGIA.
__________________________________________________________________________________________
Printed Name
__________________________________________________________________________________________
Street
City
County
State
Zip
_________________________________________________________________________________________
Social Security Number
Sex
Race
Date of Birth
___________________________________________
Signature
Sworn to and subscribed
Before me this _______ day of ___________________
20______.
_____________________________________________
Notary Public/Clerk of Probate Court
6 
 

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