
CERTIFICATE OF ADOPTION
FORM 3927 (REVISED 02/2018)
PLEASE ADDRESS ALL CORRESPONDENCE TO THE ADDRESS BELOW.
STATE OFFICE OF VITAL RECORDS1680 PHOENIX BLVD. SUITE 100, ATLANTA, GA 30349 PHONE 404.679.4702
NOTE: Sections 1 and 2 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 section 3. The clerk shall affix the seal of the
court, sign the certification and forward this certificate to: The State Office of Vital Records,
1680 Phoenix Blvd, Suite 100, Atlanta, GA 30349.
At the State Office, birth records are available from January 1919 to present. A non-refundable
vital record search fee has been established in accordance with GA Code Ann., 31-10 of the
Official Code of Georgia in the amount of $25.00. This fee includes a certified copy, if the record
is found on file. In addition to the search fee, there is a processing fee for each order. Each
additional copy, purchased at the same time, is $5.00.
Example: 1 Processing Fee $10.00
1 Search Fee $25.00
+2 Additional Copies $10.00
$45.00
If this request is being mailed, please forward this completed form with a U.S. Money Order or
certified check for the correct amount made payable to the State Office of Vital Records. A valid
copy of your Photo ID must accompany this request. Please do not send cash by mail.
GA Code Ann., 31-10-26 states that certified copies of birth certificates be issued only to
registrants (i.e. the person whose birth certificate is being requested) or any applicant having a
direct and tangible interest such as a parent, guardian, or legal representative.
PLEASE PRINT OR TYPE ALL INFORMATION LEGIBLY AND CORRECTLY BELOW.
Section 1: BEFORE ADOPTION
FIRST NAME OF CHILD AT BIRTH
DATE OF BIRTH (MONTH, DAY, & YEAR)
PLACE OF BIRTH (CITY, COUNTY, & STATE)
MOTHERS NAME AT BIRTH (FIRST, MIDDLE, LAST)
FATHERS NAME (FIRST, MIDDLE, & LAST)
Section 2: AFTER ADOPTION (INFORMATION FOR NEW BIRTH CERTIFICATE)
CURRENT LEGAL NAME: FIRST NAME OF MOTHER/PARENT 1
MIDDLE NAME OF MOTHER/PARENT 1
LAST NAME OF MOTHER/PARENT 1
FULL NAME AT BIRTH: FIRST NAME OF MOTHER/PARENT 1
MIDDLE NAME OF MOTHER/PARENT/ 1
LAST NAME OF MOTHER/PARENT 1
CURRENT LEGAL NAME: FIRST NAME OF FATHER/PARENT 2
MIDDLE NAME OF FATHER/PARENT 2
LAST NAME OF FATHER/PARENT 2
FULL NAME AT BIRTH: FIRST NAME OF FATHER/PARENT 2
MIDDLE NAME OF FATHER/PARENT 2
LAST NAME OF FATHER/PARENT 2
Page 1 of 2