Georgia Code Title 19. Domestic Relations § 19-12-3

(a) At any time after the entry of the final order of change of name, upon the request of the petitioner requesting the change of name, the clerk of the court granting the same shall issue to the petitioner a certificate of change of name, under the seal of the court, upon payment to the clerk of the fee provided in paragraph (4) of subsection (g) of Code Section 15-6-77. The certificate shall be received as evidence of the facts contained in the certificate.

(b) The certificate of change of name shall be in substantially the following form:

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)