Fill and Sign the Pennsylvania Notice of Intention to Resume Prior Surname Form

Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14 No tice of Intention to Resume Prior Surname Form 15 Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14 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. Bo x 2: Print the name of the Plaintiff exactly as it appears on Form 1. Bo x 3: Print the docket that the Prothonotary's Office wrote on Form 1 at the time of filing. Bo x 4: Print the name of the Defendant exactly as it appears on Form 1 Bo x 5: Print your current full name Bo x 6. Write either “Plaintiff” or “Defendant” (If you filed the original Divorc e Compla int, then you are the Plaintiff. If you did not file the original Divorce Complaint then you are the Defendant. Bo x 7. Write either the date the Divorce Complaint was filed or the date a Divorce Decree was granted in the appropriate space provided. Bo x 8: Write the surname (last name) of the name you wish to resume. Bo x 9. Write the date you sign the document . Bo x 10: Sign your current name. Bo x 11: S ign the name you are resuming. IF YOUR COUNTY REQUIRES THIS FORM BE NOTARIZED, DO NO T 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.Wr ite 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 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 Not ary Public will complete the rest of this form. Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14 IN THE COURT OF COMMON PLEAS OF ______ COUNTY, PENNSYLVANIA CIVIL ACTION _______________________________, : PLAINTIFF : : : Case No. ______________ vs. : : _______________________________, : DEFENDANT : IN DIVORCE NOTICE O F INTENTION TO RESUME PRIOR SURNAME P ursuant to Title 54 P.S. 704 NOTI CE 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 el ect to resume the prior surname of ___ __________________________ Date: _______________ ________________________________ Signature using your current name ________________________________ Signature using name being resumed 1 7 6 5 3 4 2 8 10 9 11 Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14 IN THE COURT OF COMMON PLEAS OF_ ______ COUNTY, PENNSYLVANIA __________________ _____________, : PLAINTIFF : : : Case No. ______________ vs. : : _______________________________, : DEFENDANT : IN DIVORCE COMMO NWEALTH OF PENNSYLVANIA COUN TY 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. Notar y Public: My Com mission Expires: 15 13 12 14 Divorce Form 15 Notice to Resume Prior Surname AOPC 7.1.14 IN THE COURT OF COMMON PLEAS OF____________ COUNTY, PENNSYLVANIA CIVIL ACTION _______________ ________________, : PLAINTIFF : : : Case No. ______________ vs. : : _______________________________, : DEFENDANT : IN DIVORCE NOTI CE OF INTENTION TO RESUME PRIOR SURNAME Pursuant to Title 54 P.S. 704 NOTI CE is hereby given that I, ________________________________ , the __________________________ (Plaintiff or Defendant) in the above- captioned case in which a: _____ Complai nt in Divorce was filed on: ____________. _____ Decree in Divorce was filed on: ____________. hereby el ect 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 IN THE COURT OF COMMON PLEAS OF_ ___________ COUNTY, PENNSYLVANIA _______________________________, : PLAI NTIFF : : : Case No. ______________ vs. : : _______________________________, : DEFENDANT : IN DIVORCE COM MONWEALTH OF PENNSYLVANIA CO UNTY OF ________________________ On t his, 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. Not ary Public: My Commission Expires: