STATE OF NORTH CAROLINA County Applicant's Current Name If Changed By Court Order Or Marriage Name Applicant Intends To Resume Applicant's Full Name At Birth Applicant's Date Of Birth Applicant's City Of Birth Applicant's County Of Birth Applicant's State Of Birth File No. In The General Court Of Justice Superior Court Division Before The Clerk APPLICATION/NOTICE OF RESUMPTION OF FORMER NAME G.S. 50-12; 101-8 TO: The Clerk Of Superior Court of the county named above. DIVORCE Resumption of maiden name, prior married name, or premarriage surname (G.S. 50-12). I am a resident of the above named county or my divorce was granted in the above named county. I have received an absolute divorce from my spouse and pursuant to G.S. 50-12 give notice of my intention to resume use of: my maiden name. the surname of a prior deceased husband. the surname of a prior living husband, and I have children who have that husband's surname. my premarriage surname. Full Name Of Former Spouse Signature In Full Maiden Name Or Premarriage Surname Date Divorce Granted County And State Where Granted DEATH OF SPOUSE Resumption of name by widow or widower (G.S. 101-8) I am a resident of the above named county and pursuant to G.S. 101-8 give notice of my intention to resume use of: my maiden name. the surname of a prior deceased husband. the surname of a previously divorced husband. my premarriage surname. Full Name Of Last Spouse (copy of death certificate of your last spouse must be attached) Signature In Full Maiden Name Or Premarriage Surname SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Signature Of Person Authorized To Administer Oaths Date Current Signature Current Name (Type Or Print) Deputy CSC Notary Assistant CSC Date My Commission Expires County Where Notarized Clerk Of Superior Court SEAL AOC-SP-600, Rev. 9/13 © 2013 Administrative Office of the Courts Original - File Copy - Applicant American LegalNet, Inc. www.FormsWorkFlow.com