This is to certify that __________________ (name of petitioner) has obtained final order of change of name in the Superior Court of __________________ County, Georgia, on the __________________ day of __________________, __________________, as shown by the records of the court.
The name (or names) of __________________ (full name prior to entry of the final order of change of name) has (or have) been changed to __________________ (full name after entry of the final order of change of name).
Given under the hand and seal of said court, this the __________________ day of __________________, __________________.
(Seal of court)
__________________ Clerk
OCGA § 19-12-3