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