Petition To Correct A Birth Certificate - Superior Court Of Cobb County (Page 2 of 5) in pdf

This Petition is being served upon the State Registrar of Vital Records, at 1600 Skyland Dr. NE

Atlanta, GA 30319, and upon the Commissioner for the Georgia Department of Human Resources at

Suite 29-250, 2 Peachtree St. NW, Atlanta, GA 30303-3142.

[If you are filing this Petition on behalf of a minor child, you must also check & complete one or both of the

following, (a) or (b), to list which people who will be served by the sheriff and which ones have signed an

Acknowledgment of Service.] Note: if you do not know where the parent or guardian lives, you will need to

consult with an attorney about how to proceed.

(a) □ In addition, the Petition is also being served by the sheriff on the minor child’s:

(i) □

Legal Guardian, whose name is___________________________________ at

the following addresses:___________________________________________________________.

(ii) □ Mother, whose name is _______________________________________ at the

following address: _________________________________________________________________.

(iii) □ Father, whose name is _______________________________________ at the

following address: _________________________________________________________________.

(b) □ The minor child’s guardian / mother / father

has/have

(circle all that apply)

acknowledged service of process and consented to the jurisdiction and venue of this Court. Their

Acknowledgment is filed with this Complaint.

I ask that this Court enter an Order to correct birth certificate because:

[Check and complete all that apply in (a) through (g) of this paragraph.]

□ (a) The Department of Vital Records has informed me that I cannot change a given name after one

year from the date of birth without a Court Order.

□ (b) The Department of Vital Records has informed me that I cannot amend an item on a birth

certificate if it was previously amended without a Court Order.

[Note: Paternity and legitimation affidavits are considered to be amendments to a birth certificate

if they have been filed with the Vital Records Office.]

□ (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.

□ (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 ______________________________.

“Instructions for Petition to Correct Birth Certificate”

Page 16 of 23

Rev 4/2017

Provided by the Superior Court of Cobb County

Petition To Correct A Birth Certificate - Superior Court Of Cobb County Page 2