INSTRUCTIONS for REQUESTING a COPY of a BIRTH CERTIFICATE

If you wish to request a copy of a birth certificate, please follow the instructions below:

1. Complete the form and submit it.
2. A copy of a valid photo ID must be provided.  You may attach it in the form or mail a copy to the court at the address listed below.
3. The cost is $25 for a certified copy and $5 for each additional copy received at the same time.
4. To complete your request, please send a cashiers check or money order to:
   Cook County Probate Court
   212 N. Hutchinson Ave.
   Adel, GA 31620
5. The check should be made out to – Cook County Probate Court
6. If you did not attach a copy of photo ID with your application, please make a copy of your photo ID and include it with your check

Any person who willfully or knowingly supplies false information on this form to be used for any purpose with the intent to defraud; willfully uses or attempts to use any certificate of birth or a copy of any record of birth knowing that such certificate was issued upon a record which was false or relates to the birth of another person may be fined not more than $10,000 or imprisoned for not more than five (5) years or both upon conviction. (Official  Code of Ga, Pursuant to O.C.G.A., Chapter 31-10, Section 31)

Birth Certificate Request Form

Personal Information

Full Name at Birth *

First

Middle

Last

Birth Name

Date of Birth

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County of Birth

Full Name of Father *

First

Middle

Last

Father's Name

Mother's Maiden Name *

First

Last

Mother's Maiden Name

Relationship *

Self, Parent, Legal Guardian, Grandparent, Adult Brother/Sister, Adult Child, Spouse, or Legal Representative

Contact Information

Address where birth certificate will be mailed *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Email *

Phone *

Miscellaneous

Upload a copy of your photo ID

Click or drag a file to this area to upload.

Photo ID

Number of copies requested *

$25 for the first copy, $5 for each additional copy

Date *

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Signature *

Additional Comments (optional)

Comment

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