File No. STATE OF NORTH CAROLINA COURT COUNTY . . . . . . . . . . . .OF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : County Print Full Name Of Applicant : Calendar No. APPLICATION/NOTICE OF JUDICIAL SUBPOENA RESUMPTION OF FORMER NAME : Plaintiff(s) Print Name Applicant Intends To Resume In The General Court Of Justice Superior Court Division Index No. Before The Clerk -against- : 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). Defendant(s) ...................................................... I am a resident of 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 PEOPLE OF THE STATE OF NEW YORK the surname of a prior deceased husband. TO 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 Date Divorce Granted GREETINGS: County And State Where Granted Signature In Full WE COMMAND YOU, that all business and excuses beingMaidenaside, you and each of you attend before laid Name Or Premarriage Surname , the Honorable at the Court located at DEATH OF SPOUSE County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed Resumption of name by widow or widower (G.S. 101-8) or adjourned date, to testify and give evidence as a witness in this action on the part of the I am a resident of the above named county pursuant to G.S. 50-12 and give notice of my intention to resume use of: Date Signed my maiden name. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the surname of a prior deceased husband. the party on whose a prior living husband,was issued for a maximum penaltyhusband's surname. the surname of behalf this subpoena and I have children who have that of $50 and all damages sustained as a result of your failure to comply. my premarriage surname. Witness, Honorable County, Full Name Of Last Spouse (copy of death certificate of your last spouse must be attached) Court in day of , one of the Justices of the Date , 20 Signature In Full Maiden Name Or Premarriage Surname (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: AOC-SP-600, Rev. 9/03 2003 Administrative Office of the Courts Original - File Copy - Applicant American LegalNet, Inc. www.USCourtForms.com