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CERTIFICATE OF ADOPTION FORM 3927 (REVISED 02/2018)

CERTIFICATE OF ADOPTION FORM 3927 (REVISED 02/2018) PLEASE ADDRESS ALL CORRESPONDENCE TO THE ADDRESS BELOW. STATE OFFICE OF VITAL RECORDS 1680 PHOENIX BLVD. SUITE 100, ATLANTA, GA 30349 PHONE 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.

CERTIFICATE OF ADOPTION FORM 3927 (REVISED 02/2018) PLEASE ADDRESS ALL CORRESPONDENCE TO THE ADDRESS BELOW. STATE OFFICE OF VITAL RECORDS 1680 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

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