Petition To Amend Birth Certificate - Superior Court Of Gwinnett County Page 7
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12☐ (b) Father's Name
Currently reads:
Should read:
☐ First Name
☐ Middle Name
☐ Last Name
☐ (c) Mother's Name
Currently reads:
Should read:
☐ First Name
☐ Middle Name
☐ Last Name
4.
The minor child’s birth certificate should be amended for the following reason:
.
5.
The Department of Vital Records will not correct the errors on the birth certificate
without a court order.
6.
I recognize that if I knowingly and willfully make a false statement in this affidavit, I will
be guilty of the crime of false swearing.
________________________________
Affiant (Signature)
Sworn to and subscribed before me
This ______ day of
______________, 20___.
_____________________________
NOTARY PUBLIC_.
Affidavit in Support of Petition to Amend Birth Certificate - Rev. March 2016
Page 2
Provided by the Gwinnett Family Law Clinic
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