928 Intake Form – The Georgia Assembly Store

928's Intake Form

All documents and information is strictly kept confidential, not shared, sold or traded!

*Instructions for filling out the form*

*You are responsible for the accuracy of submitted information. Please VIEW & REVIEW before submission*

1. Only use proper casing (Upper and Lower words).; do not use all caps (THIS IS ALL CAPS).

2. Spell out all words, no abbreviations please (GA should be spelled out Georgia, Ave is Avenue, St. is Street

3. Check your spelling and dates for accuracy

4. For any field you do not know or does not apply, put N/A

5. Birth Certificates are NOT needed at this phase. You will mail a copy, NOT originals, to the Recording Secretary at the time of processing paperwork for the Land Recording Office. You will mail the copy along with your other completed, autographed and witnessed documents. * For Baby Deeds, see below under Children

*Upon submission of form you will be contacted by a Document Service Provider to complete your payment; you can anticipate a response within 24-72 hours ( there are living men and women volunteering on the Intake Team and do their best to respond as soon as they are able). The processing of your documents will then commence upon payment completion.

*Our document packages will come to you via USPS Priority Mail. Please indicate in the final comments field if delivery needs to be otherwise.

Please select your package

928's E-Doc 928's Hard Copy 928's E-Doc + Hard Copy

Additional Documents ( Additonal Fee: $3 per page )

Who Will Be Witnessing Your Declarions?

State-of-State Public Notary Georgia Assembly Recording Secretary

Are You a Federal Employee?

Yes No

Personal Information

Sex

Man Woman

Full Current Name: *This name should be the name on your current photo ID or Passport

Your full name on your Birth Certificate *Please do not add all caps name (THIS IS ALL CAPS)

Birth Date *Example: September 04, 1972*

What Country Were You Born In?

City Where You Were Born

Born County and State: If you were born in another country, please provide the City, State, and Country of your birth *Do not abbreviate the State or Country*

List All other "legal names (by marriage, court action, divorce, etc.) *Legal names are those that have shown up on bills, notices, etc. Do no add them in ALL CAPS. Proper Casing only.

List all other "known by" names (nick names, pen names, stage names, abbreviations etc.) *For the Deed of Re-Conveyance

Select Which Best Describes You?

Born in the united States Naturalized Immigrant Green Card Immigrant 7 Year Undocumented Immigrant

If Naturalized, are you adopting Georgia as your Nation State?

Yes No I was born in The United States of America

Where you currently live:

Street Address

Apartment, suite, etc.

City

State

Zip Code

Parental Information *Needed for Paramount Claim of Life Document* For any field you do not know, put N/A

Father's Full Name

Mother's Current Full Name

Mother's Maiden Name

Parents Wedding Date: (if Parents are unmarried text unmarried in the field)

Wedding City and State: (if your parents are unmarried, simply put unmarried in the text field). If your parents were married in another country please provide the City, State, and Country they were married in. If you don't know, just put "Don't Know or N/A."

Children

*Only Needed if you have selected to add 'Baby Deed' *

If you have children under 21 years of age and you would like to have a Record of Life document created for each of them. If birth certificates are not uploaded, a baby deed (Record of Life) cannot be created. If the birth date and birth state of each parent is not on the birth certificate, you will need to type in the information in spaces below. If parental birth date and birth state are not given, we cannot create a baby deed.

For Baby Deeds to be completed, you will need to mail a copy, NOT originals, to the Recording Secretary that is processing your paperwork.

Child One: Please Enter Child's name and the Mother and Father's Full name, Date of Birth, and City and State of their birth.

Child Two: Please Enter Child's name and the Mother and Father's Full name, Date of Birth, and City and State of their birth.

Child Three: Please Enter Child's name and the Mother and Father's Full name, Date of Birth, and City and State of their birth.

Child Four: Please Enter Child's name and the Mother and Father's Full name, Date of Birth, and City and State of their birth.

Child Five: Please Enter Child's name and the Mother and Father's Full name, Date of Birth, and City and State of their birth.

Child Six: Please Enter Child's name and the Mother and Father's Full name, Date of Birth, and City and State of their birth.

Addtional Comments

Terms and Conditions:

By entering your information, you are agreeing to our simple Terms and Conditions. We complete paperwork in the order in which it was received. Your information and documents are handled manually, not using automation. Processing can take anywhere from one week to four weeks; based on the number of living men and women ahead of you. This is a custom service, once payment is made, the processing has begun. A living man or woman will have already begun putting their time into handling your document services order. We know situations can arise therefore, cancellations can only be considered and extended after an email request sent that is explaining the situation and cause for cancellation; thus to be determined case by case. There are no refunds delivered on E-Doc packages. Packages that are returned to the sender ( Recording Secretary ) will need to pay an additional re-packaging fee plus the USPS Priority shipping fee.