Petition To Amend Birth Certificate - Superior Court Of Gwinnett County Page 3
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12SUPERIOR COURT OF GWINNETT COUNTY
STATE OF GEORGIA
IN RE:
,
Civil Action
a minor child, born ________________
Case Number ______________________
,
Petitioner,
vs.
GEORGIA DEPARTMENT OF PUBLIC
HEALH/OFFICE OF VITAL RECORDS
PETITION TO AMEND BIRTH CERTIFICATE
The Petitioner, ______________________________, petitions the Court on behalf
of his/her minor child, ______________________________, to enter an Order to amend
the birth certificate of the minor child. In support of this petition, the Petitioner states
the following:
1.
The Petitioner resides in Gwinnett County, Georgia. Therefore, jurisdiction and
venue are proper in this Court.
2.
The minor child resides with the Petitioner in Gwinnett County.
3.
The Petitioner is the
mother
father of the minor child and his/her name
appears on the minor child’s birth certificate.
4.
This petition is being served upon the State Registrar of Vital Records, Georgia
Department of Human Resources, in Atlanta, Georgia.
_____________________________________________________________________________________
Petition to Amend Birth Certificate
-
Rev. April 2016
1
Provided by the Gwinnett Family Law Clinic
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