Petition To Amend Birth Certificate - Superior Court Of Gwinnett County Page 4
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125.
The Petitioner requests that this Court enter an Order to amend the birth certificate
because the Department of Vital Records has informed the Petitioner that the information
on the minor child’s birth certificate cannot be amended without a court order.
6.
The Petitioner is submitting the following documents with her petition to support
the facts alleged in the petition: ______________________________________________
_______________________________________________________________________.
7.
The Petitioner requests that the birth certificate be amended as follows:
(a) Child's Name:
Child’s First Name which currently reads:________________________ should
read: _______________________________.
Child’s Middle Name which currently reads:_______________________ should
read: _______________________________.
Child’s Last Name which currently reads:________________________ should
read: _______________________________.
(b) Father's Name
Father’s First Name which currently reads:________________________ should
read: _______________________________.
Father’s Middle Name which currently reads:_______________________ should
read: _______________________________.
Father’s Last Name which currently reads:________________________ should
read: _______________________________.
(c) Mother's Name
_____________________________________________________________________________________
Petition to Amend Birth Certificate
-
Rev. April 2016
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Provided by the Gwinnett Family Law Clinic
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