Fillable Beaver County Gov Form 15 Notice Of Intention To Resume Prior Surname

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Beaver County Gov Form 15 Notice Of Intention To Resume Prior Surname

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Instructions for:
Form 15
Notice of Intention
to Resume Prior Surname
Form 15 - Notice of Intention to Resume Prior Surname
The numbers on these instructions correspond with the numbers in the arrowboxes on the
form. Use the form with the arrowboxes to guide you through filling out the blank form.
1. Write the name of the county you are filing in by arrowbox 1. Write exactly what
you wrote on Form 1, by arrowbox 1.
2. Write the name of the Plaintiff by arrowbox 2. Write it exactly as it appears on
Form 1, by arrowbox 2.
3. Write the name of the Defendant by arrowbox 3. Write it exactly as it appears on
Form 1, by arrowbox 3.
4. 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.
5. Write your current full name by arrowbox 5.
6. Write either “Plaintiff” or “Defendant” by arrowbox 6. (If you filed the original
Divorce Complaint, then you are the Plaintiff, and your name is by arrowbox 2. If
you did not file the original Divorce Complaint then you are the Defendant, and
your name is by arrowbox 3.)
7. Write either the date the Divorce Complaint was filed or the date a Divorce
Decree was granted in the appropriate space provided.
8. Write the surname (last name) of the name you wish to resume by arrowbox 8.
9. Write the date you sign the document by arrowbox 9.
10 Sign your current signature by arrowbox 10.
11. Sign your signature with the name you are resuming by arrowbox 11.
12. File this form with the Prothonotary.
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.
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.
Form 15
Page 1 of 2
IN THE COURT OF COMMON PLEAS OF
_______________________ COUNTY, PENNSYLVANIA
_______________________________, : CIVIL ACTION – LAW
PLAINTIFF :
:
: Case No. ______________
vs. :
:
_______________________________, :
DEFENDANT : IN DIVORCE
NOTICE OF INTENTION TO RESUME PRIOR SURNAME
NOTICE is hereby given that I, ______________________________________
(your current full name), the __________________________ (Plaintiff or Defendant) in
the above-captioned case in which a:
Complaint in Divorce was filed on: ____________ (date Divorce Complaint filed)
-or-
Decree in Divorce was filed on: ____________ (date Divorce Decree filed)
I hereby elect to resume the prior surname of ___________________________________
(name being resumed) and give this written notice pursuant to the provisions of 54 P.S.
704.
Date: _________________ ________________________________
(Married Name)
Signature using your married name
_________________________________
(Prior Name)
Signature of name being resumed
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2
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5
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8
9
10
11
Form 15
Page 2 of 2
IN THE COURT OF COMMON PLEAS OF
_______________________ COUNTY, PENNSYLVANIA
_______________________________, : CIVIL ACTION – LAW
PLAINTIFF :
:
: Case No. ______________
vs. :
:
_______________________________, :
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:
12
13
14
15
IN THE COURT OF COMMON PLEAS OF
_______________________ COUNTY, PENNSYLVANIA
_______________________________, : CIVIL ACTION – LAW
PLAINTIFF :
:
: Case No. ______________
vs. :
:
_______________________________, :
DEFENDANT : IN DIVORCE
NOTICE OF INTENTION TO RESUME PRIOR SURNAME
NOTICE is hereby given that I, ______________________________________ (your
current full name), the __________________________ (Plaintiff or Defendant) in the above-
captioned case in which a:
Complaint in Divorce was filed on: ____________ (date Divorce Complaint filed)
-or-
Decree in Divorce was filed on: ____________ (date Divorce Decree filed)
I hereby elect to resume the prior surname of ___________________________________ (name
being resumed) and give this written notice pursuant to the provisions of 54 P.S. 704.
Date: _________________ ________________________________
(Married Name)
Signature using your married name
_________________________________
(Prior Name)
Signature of name being resumed
IN THE COURT OF COMMON PLEAS OF
_______________________ COUNTY, PENNSYLVANIA
_______________________________, : CIVIL ACTION – LAW
PLAINTIFF :
:
: Case No. ______________
vs. :
:
_______________________________, :
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:
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Beaver County Gov Form 15 Notice Of Intention To Resume Prior Surname

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Completed 16 November 2019

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