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IN THE SUPERIOR COURT OF COBB COUNTY

STATE OF GEORGIA

Petitioner: ____________________________________

and

Civil Action File No.: __________________________

Respondent: __________________________________

FINAL CONSENT ORDER TO AMEND MINOR CHILD’S BIRTH CERTIFICATE AND FOR NAME

CHANGE OF MINOR CHILD

COMES NOW _____________________________ (herinafter referred to as “Petitioner”) and

_____________________________ (herinafter referred to as “Respondent”), the parties in the above-styled case, and hereby indicate

their consent to entry of the within Final Consent Order. Accordingly, it is hereby ORDERED, AJUDGED, and DECREED as

follows:

Petitioner and Respondent are the parents of the subject minor child, to wit: _____________________________, born

_____________________________.

Petitioner has been legally determined to be the biological and legal Father of said child, pursuant to an Order dated

_____________________________, and signed by the Honorable Judge _____________________________ in the cased styled

_____________________________, Superior Court of _____________________________ County, Civil Action File Number

_____________________________.

At the time of issuance of the minor child’s Birth Certificate, Respondent entered ___________________________ under the

section of the Birth Certificate identifying the child’s Father.

Petitioner now moves the Court to amend the minor child’s Birth Certificate to insert Petitioner’s name,

_____________________________, (Input full name of Father as you want it to appear on the Birth Certificate), as the Father of the

minor child, and remove “_____________________________” (Input Father’s name as it currently appears on original Birth

Certificate. If Mother was married at the time of birth to someone other than the Father and put “refused” on the Birth Certificate,

input “refused” and the full name of the Mother’s spouse.) from the section of the child’s Birth Certificate entitled “Father’s Name.”

The Court herby ORDERS that the name “_____________________________” (Input Father’s name as it appears on the

original Birth Certificate) and/or “REFUSED” be removed as the “Father’s Name” under said section of the Birth Certificate, and that

the name _____________________________ (Input full name of Father as you want it to appear on the Birth Certificate) be added

under “Father’s Name” on the Birth Certificate. Accordingly, it is ORDERED that the name “_____________________________”

________________________________________________________________________________________________________________

“Final Consent Order to Amend Minor Child’s Birth Certificate and For Name Change of Minor Child”

Page 1 of 2

Provided by the Superior Court.of Cobb County.

rev 1. 05/2008

Final Consent Order To Amend Minor Child'S Birth Certificate And For Name Change Of Minor Child Form - Superior Court Of Cobb County