REPORT OF DIVORCE, ANNULMENT OR DISSOLUTION OF MARRIAGE
FORM 3907
(REVISED 12/2016)
PLEASE ADDRESS ALL CORRESPONDENCE TO THE ADDRESS BELOW.
STATE OFFICE OF VITAL RECORDS1680 PHOENIX BLVD. SUITE 100, ATLANTA, GA 30349 PHONE 404.679.4702
PLEASE PRINT OR TYPE ALL INFORMATION LEGIBLY AND CORRECTLY BELOW.
REQUIRED INFORMATION
CIVIL ACTION NUMBER
DATE DECREE GRANTED (MONTH, DAY, YEAR)
COUNTY DECREE GRANTED
FIRST NAME OF PARTY 1
MIDDLE NAME
LAST NAME
DATE OF BIRTH (MONTH, DAY, YEAR)
COUNTY OF RESIDENCE
NUMBER OF THIS MARRIAGE (FIRST, SECOND, ETC.)
FIRST NAME OF PARTY 2
MIDDLE NAME
LAST NAME
DATE OF BIRTH (MONTH, DAY, YEAR)
COUNTY OF RESIDENCE
NUMBER OF THIS MARRIAGE (FIRST, SECOND, ETC.)
SPECIFY GROUNDS FOR DIVORCE (19-5-3, OCGA)
NUMBER OF CHILDREN LESS THAN 18 AFFECTED BY THIS DECREE
This above Report may be reproduced by use of a computer. However, the finished Report
must be a close reproduction of the original, and prior review and approval must be obtained
from the State Registrar before use. (31-10-7, O.C.G.A.)
31-10-22. Record of divorce, dissolutions, and annulments.
(a) A record of each divorce, dissolution of marriage, or annulment granted by any court of
competent jurisdiction in this state shall be filed by the clerk of the court with the department
and shall be registered if it has been completed and filed in accordance with this Code section.
The record shall be prepared by the petitioner or the petitioner’s legal representative on a form
prescribed and furnished by the state registrar and shall be presented to the clerk of the court
with the petition. In all cases, the completed record shall be a prerequisite to the granting of
the final decree.
(b) The clerk of the superior court shall complete and forward to the department on or before
the tenth day of each calendar month the records of each divorce, dissolution of marriage, or
annulment decree granted during the preceding calendar month.
CHEROKEE