Notice To Resume Prior Surname
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Notice To Resume Prior Surname Form. This is a Pennsylvania form and can be use in Dauphin Local County.
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Tags: Notice To Resume Prior Surname, Pennsylvania Local County, Dauphin
IN THE COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA
CIVIL DIVISION
:
:
Plaintiff :
:
:
:
:
:
Defendant :
Vs.
File No.
IN DIVORCE
NOTICE TO RESUME PRIOR SURNAME
Notice is hereby given that the
Plaintiff
Defendant in the above matter,
[Select one of the following]
prior to the entry of a Final Decree in Divorce,
or
after the entry of a Final Decree in Divorce dated
hereby elects to resume the prior surname of
,
, and gives this
written notice avowing his/her intention pursuant to the provisions of 54 P.S. § 704.
Date:
Signature
Signature of name being resumed
COMMONWEALTH OF PENNSYLVANIA
)
COUNTY OF
)
SS.
)
On the
day of
,
, before me, the Prothonotary or a Notary Public, personally
appeared the above affiant known to me to be the person whose name is subscribed to the within
document and acknowledged that he/she executed the foregoing for the purpose therein contained.
In Witness Whereof, I have hereunto set my hand and official seal.
Prothonotary or Notary Public
Proth. – 61
(Rev. 4/01)
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