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Georgia Name Change Verification Form

Once a name change applicant completes the petition, s/he must attach this form to the petition. This action allows for the notarization of the petition.Download

Extracted Text for Proper Search

I 	
STATE OF GEORGIA 
FAMILY  DIVISION 	
Civil 	Action 	File 	No: 	_______ 	_ 	
Petitioner:--------------	
VERIFICATION 	
I, 	[1] 	, 	personally 	appeared  before the undersigned  Notary 	Public, 	and 	say 
under  oath that 	
I 	am 	the Petitioner 	in 	the 	above-styled 	action 	and 	that  the facts  stated 	in 	the Petition  to 
Change  Name (of 	
an 	Adult) 	are true  and correct. 
This  the 	
_________ 	day of 	____________ 	_ 	
[date] 	
Sworn  to and  subscribed  before 	me, 	this 	
___ 	dayof 	___________ 	__ 	
NOTARY 	PUBLIC 	
My 	Commission  Expires: 
(Notary 	
Seal) 	
[month]  [year] 
[2] 	_______________ 	_ 	
(Sign 	your name  here in 	front 	of 	the 	Nctary) 	
Petitioner=s 	name  (print or type): 	_______ 	_ 	
Petitioner=s 	address:. 	____________ 	_ 	
Petitioner=s 	telephone 	num 	ber:...l.---'-------	
If 	you  require  materials 	in 	alternate  format, 	please 	notify 	the 	Family 	Law 	Information  Center 	as soon  as possible. 	
Verification-rev.  9/99  Page 1 	of 	1 	
I
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