DEKALB COUNTY SUPERIOR COURTSTATE OF GEORGIA ,Petitioner,vs. ,Respondent(s).Civil Action Case Number MOTHER222S CONSENT TO LEGITIMATION1.I am the mother of following minor child(ren), who are the subject of this legitimationaction filed by the Petitioner:Current Name of ChildMale / FemaleYear of Birth2.I hereby give my consent to the following provisions, by writing my initials next to them. I do not agree to any of the provisions unless I have written my initials next to them.[Write your initials next to only the ones to which you agree.Draw a line through the ones to which you do not agree](a)The Petitioner legitimating our children, whose names are listed in Paragraph 1above.Mother222s Consent to Legitimation 227 Rev. July 19, 2005 - Tech. Rev. 10-2015 & 05-2017Page 1 of 3Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.FormsWorkFlow.com [Write your initials next to only the ones to which you agree.Draw a line through the ones to which you do not agree] (b)Changing the children222s last name to . (c)I agree to the following arrangement concerning custody and visitation: (d)On the issue of child support:[Write your initials next to only one of the following, (1) to (4).](1)Child support has already been decided for these children by a court oragency in another case.(2)I want the Court to decide child support and enter an child support orderas part of this legitimation case.(3)The Petitioner and I have reached an agreement on child support for thesechildren, and it is consistent with the Georgia child support guidelines. The Petitioner222s gross income is $ per month, and my gross income is $ per month. We have agreed that will pay child support in the amount of $ per month to .(4)The parties live together with the children, so no child support order isnecessary.Mother222s Consent to Legitimation 227 Rev. July 19, 2005 - Tech. Rev. 10-2015 & 05-2017Page 2 of 3Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.FormsWorkFlow.com 3.I have read this consent document, and I understand it. I am giving my consentfreely. I have written my initials next to all of the provisions in Paragraph 2 to which I amagreeing. I am not being forced to sign this consent, and I believe this legitimation is in thebest interest of my child(ren).Subscribed & sworn to before me on , 20 . Notary Public Commission Expires: Mother / Respondent (Signature) Mother222s Name: Her Address: Her Phone (day): ( ) Email: pro se Legit Mother Consent 2 rev - Tech rev 2015-102017-05.wpdMother222s Consent to Legitimation 227 Rev. July 19, 2005 - Tech. Rev. 10-2015 & 05-2017Page 3 of 3Provided by the DeKalb County Superior Court and the Atlanta Legal Aid Society American LegalNet, Inc. www.FormsWorkFlow.com