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