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Get GA 3927 1983

S T A T E A D O P TI O N CERTIFICATE OF ADOPTION - GEORGIA FILE NUMBER T Y P E O R P R IN T A L L IN F O R M A T I O N IN B L A C K O R B L U E -B L A C K P E R M A N E N T IN K. PAR TS I A ND II OF THIS CERTIFICATE ARE TO BE COMPLETED BY THE PETITIONER ATTORNEY FOR THE PETITIONER OR THE CHILD-PLACING AGENCY REPRESENTATIVE AS APPLICABLE AND FILED ALONG WITH THE PETITION OR DECREE. WHEN THE FINAL ORDER OF ADOPTION HAS BEEN DECREED THE CLERK OF COURT SHALL COMPLETE THE CERTIFICATION INFORMATION BELOW IN PAR T III. PAR TS I A ND II OF THIS CERTIFICATE ARE TO BE COMPLETED BY THE PETITIONER ATTORNEY FOR THE PETITIONER OR THE CHILD-PLACING AGENCY REPRESENTATIVE AS APPLICABLE AND FILED ALONG WITH THE PETITION OR DECREE. WHEN THE FINAL ORDER OF ADOPTION HAS BEEN DECREED THE CLERK OF COURT SHALL COMPLETE THE CERTIFICATION INFORMATION BELOW IN PAR T III. THE CLERK SHALL AFFIX THE SEAL OF COURT SIGN THE CERTIFICATION AND FORWARD THIS CERTIFICATE TO VITAL RECORDS SERVICE RM 217-H 47 TRINITY AVENUE S.W. ATLANTA GEORGIA 30334. S T A T E A D O P TI O N CERTIFICATE OF ADOPTION - GEORGIA FILE NUMBER T Y P E O R P R IN T A L L IN F O R M A T I O N IN B L A C K O R B L U E -B L A C K P E R M A N E N T IN K. PAR TS I A ND II OF THIS CERTIFICATE ARE TO BE COMPLETED BY THE PETITIONER ATTORNEY FOR THE PETITIONER OR THE CHILD-PLACING AGENCY REPRESENTATIVE AS APPLICABLE AND FILED ALONG WITH THE PETITION OR DECREE* WHEN THE FINAL ORDER OF ADOPTION HAS BEEN DECREED THE CLERK OF COURT SHALL COMPLETE THE CERTIFICATION INFORMATION BELOW IN PAR T III. THE CLERK SHALL AFFIX THE SEAL OF COURT SIGN THE CERTIFICATION AND FORWARD THIS CERTIFICATE TO VITAL RECORDS SERVICE RM 217-H 47 TRINITY AVENUE S*W* ATLANTA GEORGIA 30334. PART 1 - BEFORE ADOPTION NAME OF CHILD AT BIRTH FIRST MIDDLE LAST SEX DATE OF BIRTH MO. DAY YR* PLACE OF BIRTH CITY COUNTY STATE MAIDEN NAME OF MOTHER FIRST MIDDLE LAST ORIGINAL BIRTH CERTIFICATE NO. NAME OF NATURAL FATHER FIRST MIDDLE LAST PART II - AFTER ADOPTION -INFORMATION FOR NEW BIRTH CERTIFICATE 9a* MOTHER CHECK ONE 9b. ADOPTIVE MOTHER - DATE OF BIRTH MO. DAY YR* 9c* MOTHER - PLACE OF BIRTH STATE OR COUNTRY 9d. NATURAL RESIDENCE OF ADOPTIVE MOTHER AT TIME OF CHILD S BIRTH STREET OR R*F*D. NO. CITY TOWN STATE ZIP 9e. COMPLETE NAME OF FATHER FIRST MIDDLE LAST 10a* 10b. 10c* 10d. CURRENT ADDRESS OF ADOPTIVE PARENTS STREET OR R*F*D. NO. CITY TOWN STATE ZIP A NEW BIRTH CERTIFICATE IN THE ADOPTED CHILD S NEW NAME WHICH SHOWS THE ADOPTIVE PARENT S NAMES WILL BE PREPARED UNLESS THIS BOX IS CHECKED. 12a* SIGNATURE OF INFORMANT 13a* 13b. TITLE OF INFORMANT TYPE OR PRINT ATTORNEY S NAME 13c* 13d. PART III - CERTIFICATION INFORMATION DATE DECREE ENTERED MO. DAY YR COURT FILE NUMBER COUNTY OF COURT THE PLACE OF BIRTH SHALL BE AS INDICATED ON THE FINAL DECREE OF ADOPTION HEREBY CERTIFY THAT HTE FINAL DECREE OF ADOPTION CONCERNING THE ABOVE NAME PERSONS WAS ENTERED IN THIS COURT. 18. SIGNATURE OF CL ERK CITY COUNTY I FORM 3927 RE*7-83 GEORGIA DEPARTMENT OF HUMAN RESOURCES/VITAL RECORDS SERVICE PLACE SEAL OVER SIGNATURE. .

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