Notice of Intention to Resume Prior Surname Form 1 Divorce Form 1 Notice o Re Prior Form 1 - Notice of Intention to Resume Prior Surname The numbers on these instructions correspond with the numbers in the boxes on the form. Use the form with the boxes to guide you through filling out the blank form. Box 1: Print the name of the county in which you filed exactly as it appears on Form 1. Box 2: Print the name of the Plaintiff exactly as it appears on Form 1. Box 3: Print the docket that the Prothonotary's Office wrote on Form 1 at the time of filing. Box 4: Print the name of the Defendant exactly as it appears on Form 1 Box 5: Print your current full name Box 6 either 223Plaintiff224 or 223Defendant224 (If you filed the original Divorce Complaint, then you are the Plaintiff. If you did not file the original Divorce Complaint then you are the Defendant. Box 7 the date the Divorce Complaint was filed or the date a Divorce Decree was granted. Box : the surname (last name) of the name you wish to resume. Box the date you sign the document. Box 1:Sign your current name. Box 1: Sign the name you are resuming. the docket number. The docket number is the 1 IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA CIVIL ACTION 2 , : PLAINTIFF : 3 : : Case No. 4 vs. : : , : DEFENDANT : IN DIVORCE NOTICE OF INTENTION TO RESUME PRIOR SURNAME Pursuant to Title 54 P.S. 704 5 NOTICE i hereby given that I, , the (Plaintiff or Defendant) in the above- captione case in which a: Complaint in Divorce was filed on: . hereby elect to resume the prior surname of Date: 1 Signature using your current name 1 Signature using name being resumed 1 IN T COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA , : PLAINTIFF : 1 : : Case No. vs. : : , : DEFENDANT : 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: IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA CIVIL ACTION , : PLAINTIFF : : : Case No. vs. : : , : DEFENDANT : 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 above-captioned case in which a: Complaint in Divorce was filed on: Decree in Divorce was on: . hereby elect to resume the prior surname of Date: Signature using your current name Signature using name being resumed IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA , : PLAINTIFF :::Case No. vs. ::, : DEFENDANT : 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: