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Notice of Intention to Resume Prior Surname

Form 15

Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14

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Form 15 - 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. Write either “Plaintiff” or “Defendant” (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. Write either the date the Divorce Complaint was filed or the date a Divorce Decree was granted in the appropriate space provided.

Box 8: Write the surname (last name) of the name you wish to resume.

Box 9. Write the date you sign the document.

Box 10: Sign your current name.

Box 11: Sign the name you are resuming.

IF YOUR COUNTY REQUIRES THIS FORM BE NOTARIZED, DO NOT SIGN THIS FORM UNTIL YOU ARE IN FRONT OF A NOTARY PUBLIC, AND COMPLETE THE REMAINDER OF THE INSTRUCTIONS ON PAGE 2 OF THE FORM:

  1. Write the name of the county you are filing in by arrowbox 1. Write exactly what you wrote on Form 1, by arrowbox 1.
  2. Write your name by arrowbox 2. Write your name exactly as you wrote it on Form 1, by arrowbox 2.
  3. Write your spouse's name by arrowbox 3. Write your spouse's name exactly as you wrote it on Form 1, by arrowbox 3.

Divorce Form 15

Notice to Resume Prior Surname

AOPC 7.1.14

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  • 14. Write the docket number by arrowbox 4. The docket number is the number that the Prothonotary's Office wrote on Form 1, by arrowbox 4 at the time of filing.

The Notary Public will complete the rest of this form.

Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14

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1 IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA CIVIL ACTION

PLAINTIFF 4 vs. DEFENDANT Case No. 3 IN DIVORCE

NOTICE OF INTENTION TO RESUME PRIOR SURNAME Pursuant to Title 54 P.S. 704

NOTI c____6 hereby given that I, _____，

the ___ (Plaintiff or Defendant) in the above-

capt id 7 se in which a:

Complaint in Divorce was filed on: ___.

___ Decree in Divorce was filed on: ___.

hereby elect to resume the prior surname of 8

Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14

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12 13 COURT OF COMMON PLEAS OF 12 COUNTY, PENNSYLVANIA 13 COURT OF COMMON PLEAS OF 13 COUNTY, PENNSYLVANIA

IN 13 OURT OF COMMON PLEAS O PLAINTIFF 15 VS. DEFFENDANT Case No. 14

underbrace IN 13OURT OF COMMON PLEAS OFunderbrace □ □,: COUNTY, PENNSYLVANIA

DEFENDANT : IN DIVORCE

Case No. boxed 14

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 15 Notice to Resume Prior Surname AOPC 7.1.14

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IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA CIVIL ACTION

Print the name of the county in which you are filing, exactly as it appears on other forms.

PLAINTIFF

VS. ___

Print Defendant's name exactly as it appears on other forms.

DEFENDANT IN DIVORCE

Case No. _____

Print the docket number exactly as it appears on other forms.

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:

Print your current full name
Print either “Plaintiff” or “Defendant” (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.

___ Complaint in Divorce was filed on: ___.

Write either the date the Divorce Complaint was filed or the date a Divorce Decree was granted in the appropriate space provided.
Check either the date the Divorce Complaint was filed or the date a Divorce Decree was granted in the appropriate space provided.

___ Decree in Divorce was filed on: ___.

Print the date you sign the document
Check either the date the Divorce Complaint was filed or the date a Divorce Decree was granted in the appropriate space provided.

hereby elect to resume the prior surname of ___

Print the surname (last name) of the name you wish to resume.
Sign your current name.

Date: _____

Print the date you sign the document

Signature using your current name

Sign the name you are resuming.

Signature using name being resumed

Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14

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IN THE COURT OF COMMON PLEAS OF_____ COUNTY, PENNSYLVANIA

Print the name of the county in which you are filing, exactly as it appears on other forms.
Print Plaintiff's name exactly as it appears on other forms.

PLAINTIFF

VS. Case No. ___

Print Defendant's name exactly as it appears on other forms.

DEFENDANT : IN DIVORCE

Case No.

Print the docket number exactly as it appears on other forms.

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 15 Notice to Resume Prior Surname AOPC 7.1.14

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IN THE COURT OF COMMON PLEAS FOR ADAMS COUNTY, PENNSYLVANIA CIVIL ACTION - LAW

Name1(CICForm)
NamePLAINTIFF
vs.
NameDEFENDANT 1
and (if applicable)
NameDEFENDANT 2
Name2(CICForm)
Name3(CICForm)
Case(CICForm)

CASE NO. _____

CERTIFICATE OF COMPLIANCE

I certify that this filing complies with the provisions of the Case Record 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.

Signature: _____

Petitioner Date: _____

Print Name: _____

Name4(CICForm)

Date:

Date(CICForm)