Notice To Resume Prior Surname (Death)
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Notice To Resume Prior Surname (Death) Form. This is a Pennsylvania form and can be use in Luzerne Local County.
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Tags: Notice To Resume Prior Surname (Death), Y-3F-1, Pennsylvania Local County, Luzerne
IN THE COURT OF COMMON PLEAS OF _______________ COUNTY, PENNSYLVANIA
CIVIL DIVISION
IN RE:
NAME CHANGE OF
SURVIVING SPOUSE
:
:
:
:
:
:
File No.___________________________
NOTICE TO RESUME PRIOR SURNAME
Notice is hereby given that ______________________________________________,
(Name)
a surviving spouse of ___________________________________________ elects to resume
(Decedent)
the prior surname of _____________________________________________, and gives this
written notice avowing his / her intention pursuant to the provisions of 54 P.S. ยง 704.1.
Date: ________________
_____________________________________
Signature
____________________________________
Signature of name being resumed
(Note: This notice must be accompanied by an original certificate of death for the decedent.)
Y-3F-1
(4/05)
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