IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA CIVIL DIVISION : : Plaintiff : : File No. vs. : : IN DIVORCE : Defendant : 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. 704(a). Date: Signature Signature of Resumed Name COMMONWEALTH OF PENNSYLVANIA) ) SS. COUNTY OF LEHIGH ) On the day of , , before me, 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. Notary Public (Rev.01/01)