===== PAGE 1 ===== # Notice of Intention to Resume Prior Surname Form 15 ===== PAGE 2 ===== ## 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: 11. Write the name of the county you are filing in by arrowbox 1. Write exactly what you wrote on Form 1, by arrowbox 1. 12. Write your name by arrowbox 2. Write your name exactly as you wrote it on Form 1, by arrowbox 2. 13. 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 ===== PAGE 3 ===== 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. ===== PAGE 4 ===== 1 IN THE COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA CIVIL ACTION
Image
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, _____，
Image
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 8 Date: 9
Image
10 Signature using your current name 11 Signature using name being resumed ===== PAGE 5 ===== 12 13 COURT OF COMMON PLEAS OF 12 COUNTY, PENNSYLVANIA 13 COURT OF COMMON PLEAS OF 13 COUNTY, PENNSYLVANIA
Image
IN 13 OURT OF COMMON PLEAS O PLAINTIFF 15 VS. DEFFENDANT Case No. 14 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: ===== PAGE 6 ===== # 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 filed on: ___. hereby elect to resume the prior surname of ___ Date: _____ Signature using your current name Signature using name being resumed Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14 ===== PAGE 7 ===== IN THE COURT OF COMMON PLEAS OF_____ COUNTY, PENNSYLVANIA ， PLAINTIFF VS. Case No. ___ 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: Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14 ===== PAGE 8 ===== # IN THE COURT OF COMMON PLEAS FOR ADAMS COUNTY, PENNSYLVANIA CIVIL ACTION - LAW
NamePLAINTIFF
vs.
NameDEFENDANT 1
and (if applicable)
NameDEFENDANT 2
Image
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: _____