Birth Certificate Request Form

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

**For mail request: Once our office receives your request, a clerk will give you a call to process your payment by phone.

We currently offer two options to have your documents mailed to you: FedEx (for an additional fee) or USPS

FedEx: $12.75 (2 - 3 day delivery with tracking number)

USPS: Free (NO tracking number)

(By filling out and submitting this form, you are agreeing that Worth County Probate Court is not responsible should your mail get lost after it leaves our office.)

Full Name at Birth:

Date of Birth:

County of Birth:

Mother's Maiden Name:

Father's Name:

Name of Requestor:

Relationship:

Requestor Address:

Requestor Phone Number:

Requestor Email:

Number of Copies:

Mail or Pickup?

FedEx or USPS? (for mail request):

Valid Photo ID is REQUIRED

One file only.
2 MB limit.
Allowed types: gif jpg tif pict txt pdf doc docx.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

View PDF of Page