Petition To Correct A Birth Certificate Form - Dekalb County Superior Court (Page 3 of 5) in pdf

Petition To Correct A Birth Certificate Form - Dekalb County Superior Court Page 3

G (c) The Department of Vital Records has informed me that I cannot correct the year of birth by

more than one year on a birth certificate without a court order.

G (d) The minor child was born at ____________________________________

(name of hospital)

and the child’s mother was admitted to the hospital under her maiden name of ___________

_______________________, rather than her married name of ________________________ .

The hospital did not ask about her marital status or the name of the father. When Petitioner

contacted the Department of Vital Records to straighten out the matter, Petitioner was told

they needed to have a court order to correct the child’s birth certificate.

Because the parents were married before the child’s birth and continue to be married, this

child is automatically presumed to be a child of the marriage and, but for the error on the part

of the hospital, the child would have the father’s surname and his name would be listed on the

birth certificate. See Affidavit of ____________________________________________.

(Name of Parent signing Affidavit)

G (e) The minor child is over one year old.

G (f) I do not speak English. I provided the correct information to the staff at the hospital where the

minor child was born, but the hospital staff failed to correctly write down the information I

provided to them.

G (g) The Department of Vital Records has informed me that a Court order is needed for the

following reasons:

[Note: If the Department of Vital Records has informed you that you must obtain a

court order for a reason other than one listed above, you should consult a lawyer to

see whether or not this form can assist you in filing your petition.]

[You must check and file copies of at least one of the following

documents, (a) through (h), to support your Petition.]

I have checked below to show the documents I am filing with my petition to support the facts

I have stated in my request:

G (a) Certified copy of the birth certificate that needs to be corrected

G (b) Birth certificate(s) of minor child’s parent(s) who are listed on the birth certificate

Petition to Correct Birth Certificate —

Page 3 of 5

Approved March 19, 2010

Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society

Petition To Correct A Birth Certificate Form - Dekalb County Superior Court Page 3