Filing Maiden Names Return To: Prothonotary Office, Family Court Division Bucks County Justice Center 100 North Main St. Doylestown, PA 18901 Please fill out the enclosed form and send the original, signed in blue ink, along with a check or money order payable to 223Prothonotary224 in the sum of $9.25, and a self-addressed, stamped envelope to the above address. We will return 5 certified copies to you via your self-addressed, stamped envelope so that you can take them to the necessary places to have your name properly change. Thank You The staff at the Prothonotary Office, Family Court THE COURT OF COMMON PLEAS OF BUCKS COUNTY OFFICE OF PROTHONOTARY 100 N Main Street Doylestown, PA 18901 (215) 348-6822 Randall Flager, Esq. Solicitor Patricia A. Zimmerman First Deputy Saul Weiss Second Deputy Judith J. Reiss Prothonotary American LegalNet, Inc. www.FormsWorkFlow.com IN THE COURT OF COMMON PLEAS OF BUCKS COUNTY, PENNSYLVANIA CIVIL DIVISION : : Plaintiff : VS. : A06- : Defendant : IN DIVORCE NOTICE TO RESUME PRIOR SURNAME Notice is hereby given that the Plaintiff / Defendant in the above matter, is a party in this DIVORCE ACTION and hereby elects to resume the prior surname of , and hereby gives this written notice pursuant to the provisions of 54 P.S. 247 704(a). Date: Signature Signature of Resumed Name American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF COMPLIANCE I certify that this filing complies with the provisions of the Public Access Policy of the Unified Judicial System of Pennsylvania: Case Records of the Appellate and Trial Courts that require filing confidential information and documents differently than non-confidential information and documents. Submitted by: Signature: Name: Attorney No. (if applicable): Case Docket Number: American LegalNet, Inc. www.FormsWorkFlow.com