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