SOP_NUMBER: 214.03-att-1
TITLE: Request for a Certified Copy of a Vital Record
REFERENCE_CODE: IIA16-0001
DIVISION: Facilities
TOPIC_AREA: 214 Policy-Facilities Programs
EFFECTIVE_DATE: 2015-04-23
WORD_COUNT: 255
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/106126
URL: https://gps.press/sop-data/214.03-att-1/

SUMMARY:
This form allows inmates and probationers housed in Georgia Department of Corrections facilities to request certified copies of vital records (birth, death, or marriage certificates) registered in Georgia. The request must be approved by a counselor and the warden/superintendent before being submitted to the Georgia Department of Human Resources Vital Records Branch, with applicable fees collected by the business office.

KEY_TOPICS: vital records, birth certificate, death certificate, marriage certificate, certified copy, inmate request, probationer request, vital records request form, Georgia vital records, record request procedure

ATTACHMENTS:
  1. Request for a Certified Copy of a Vital Record
     URL: https://gps.press/sop-data/214.03-att-1/

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FULL TEXT:
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Attachment 1

IIA16-0001

(214.03)
04/23/15

# **REQUEST FOR A CERTIFIED COPY OF A VITAL RECORD**

**ONLY COPIES OF VITAL RECORDS REGISTERED IN GEORGIA ARE**
**AVAILABLE. A separate form must be completed for each type of vital record and**
**for each person for whom a certified copy of a vital record is requested.**
**To: Vital Records Branch**
**DHR 2600 Skyland Drive N.E.**
**Atlanta, Georgia 30319-3640**
# **From: Warden/Superintendent ________________________________** **____________________________________________________________** **(Warden/Superintendent’s name and mail address entered in this space)** **Inmate ____________________     EF_____________________**

**I am requesting a certified copy of a BIRTH  DEATH    MARRIAGE**
**certificate**
**(CIRCLE ONLY ONE TYPE OF CERTIFICATE )**
Total number of copies requested____________________
**in the name of ________________    SEX_____    RACE___________**
**DATE** the birth, death or marriage occurred_____________________________
Month      Day           Year
**COUNTY** where the birth, death or marriage occurred____________________
**RELATIONSHIP** to person named on the certificate_____________________
**For Birth Certificate Search ONLY – Parent’s Names:**
Mother’s Maiden Name: ____________________________________________
Father’s Name:____________________________________________________
The following circumstance (s) exist which necessitates that a copy of a vital record as
indicated above be issued:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________              _________________
Inmate’s Signature Date Signed
I hereby authenticate this request for the above record
__________________________________________Approved  Disapproved (circle one)
Counselor’s Signature              Date Signed
_________________________________________ Approved  Disapproved (circle one)
Warden/Superintendent’s Signature   Date Signed

Total **FEE** enclosed: $__________ ($10.00 for the first copy. $5.00 each for additional
copies of the same certificate ordered at the same time.)
_________________________________________
Business Office Signature          Date Signed

**RETENTION SCHEDULE:** **A copy of this attachment will be placed in the inmate/probationer administrative/case history**
**file and will be retained according to the official records retention schedule for that file.**