Petition To Correct A Birth Certificate Form - Dekalb County Superior Court Page 5

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8.
I do not intend to defraud or cheat anyone by this request.
THEREFORE, I ask that this Court enter an order to direct that this birth certificate be corrected.
Dated:
Petitioner, Pro se (Signature)
Name:
Address:
Phone (daytime): (
)
Petition to Correct Birth Certificate —
Page 5 of 5
Approved March 19, 2010
Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society

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