IN THE COURT OF COMMON PLEAS OF____________ COUNTY, PENNSYLVANIA CIVIL ACTION _______________________________, : PLAINTIFF : : : vs. : : _______________________________, : DEFENDANT : Case No. ______________ IN DIVORCE NOTICE OF INTENTION TO RESUME PRIOR SURNAME Pursuant to Title 54 P.S. 704 NOTICE is hereby given that I, ________________________________ , the __________________________ (Plaintiff or Defendant) in the abovecaptioned case in which a: _____ _____ Complaint in Divorce was filed on: ____________. Decree in Divorce was filed on: ____________. hereby elect to resume the prior surname of _____________________________ Date: _______________ ________________________________ Signature using your current name ________________________________ Signature using name being resumed Divorce Form 11 Notice to Resume Prior Name AOPC 7.1.14 American LegalNet, Inc. www.FormsWorkFlow.com IN THE COURT OF COMMON PLEAS OF____________ COUNTY, PENNSYLVANIA _______________________________, : PLAINTIFF : : : vs. : : _______________________________, : DEFENDANT : Case No. ______________ IN DIVORCE COMMONWEALTH OF PENNSYLVANIA COUNTY OF ________________________ On this, the _______ day of ___________________________, 20_____, personally appeared before me, a Notary Public in and for said Commonwealth and County, ________________________________________ (full married name), known to me (or satisfactorily proven) to be the person who is the person whose name is subscribed to the within document and acknowledged that she executed the same for the purposes therein contained. Notary Public: My Commission Expires: Divorce Form 11 Notice to Resume Prior Name AOPC 7.1.14 American LegalNet, Inc. www.FormsWorkFlow.com