Document for Cantanius Allen VS Terrell Allen

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                                                REPORT OF DIVORCE, ANNULMENT OR DISSOLUTION OF MARRIAGE * FORM 3907
           dae
‘oeepe Ormtmant
           of Ae Haste
                                                                                                                                                   (REVISED 12/2016)




                         PLEASE PRINT OR TYPE ALL INFORMATION LEGIBLY AND CORRECTLY BELOW.



         EL‘GVILACTION NUMBER                                        DATE DECREE GRANTED (MONTH, DAY, YEAR)               ‘COUNTY DECREE GRANTED

           FIRST NAME GF PARTY                         WIDDLE NAME                             TAST NAME                                 AST NAMEAT BIRTH
           sperre |                                        1                                     Avien                                       AEN
           DATE OF BIRTH MON, 1, DAY,   YEAR)                        ‘COUNTYOF RESIDENCE                                   NUMBER OFTHIS “yest FIRST, SECOND, ETC)
                      —
          "HAST NAME OF PARTY 2                        may                vera                  b
                                                                                                USTNAME
               Ortanus                                                                           Allen
           ‘DATE CF BIRTH [MONTH, DAY, YEAR)
             {~|w-713
          {SPECIFY GROUNDS FOR DIVORCE (5-5-3, OCGA)
                                                                     BEEAIb                                                NUMBER OF THis MARRIAGE (FIRST, SECOND, ETC)

                                                                                                NUMBER OF CHILDREN LESS THAN 18 AFFECTED 8Y THIS DECREE
            Adultry,                            Bom            S*'C             alien                                    Le

         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, O0.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 shail 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.




                                PLEASE ADDRESS ALL CORRESPONDENCE TO THE ADDRESS BELOW.
          STATE OFFICE OF VITAL RECORDS | 1680 PHOENIX BLVD. SUITE 100, ATLANTA, GA 30349 | PHONE 404.679.4702