Georgia Secretary of State Authentication Request Form

Date (Fecha): June 1, 2015

Contact Name (Nombre y apellido del solicitante): Mike Thompson
Address (Direccin): Care of: 2845 East Woglesworth Place
City (Ciudad):Terranova State (Estado): Your state Zip (Cdigo Postal)[12345]
Daytime Telephone Number (Numero de telfono): (555)555-5555
Country Each Document will go to (Pas en que se destina el documento):Jamaica
Number of Documents (Cantidad de Documentos) 2 x $10.00 = $20.00

Confirm this checklist prior to submitting your documents:

X Documents
X Check or Money Order payable to Office of the Secretary of State $10.00 per authentication
X Name of the country of destination has been provided
X Enclosed self-addressed stamped envelope or prepaid overnight delivery label for return of documents
Mailing Address:
Office of the Secretary of State
2 Martin Luther King Drive SE
Suite 802-Floyd West Tower
Atlanta, Georgia, 30334
There is no official form to request the Authentication for non hague Treaty Countries. I followed the instructions and
sent these documents to gscca. They sent them back. I called your office and the lady I spoke with told me to create a
cover letter. She also told me the fee is 10.00 per document. Enclosed are two (2) money orders. 1 in the amount of 12.00
and the other in the amount of 6.00, along with the requirements for the Authentication. Ive also included a true and
correct copy of the document sent back from GSCCCA. Please be advised that the copy is for reference only.Thank you
in advance for your assistance in this matter. My contact information is listed above.