IN THE COURT OF COMMON PLEAS OF DELAWARE COUNTY, PENNSYLVANIA
CIVIL DIVISION
____________________________ NO.___________________________
Plaintiff
vs.
_______________________________ IN DIVORCE
Defendant
NOTICE OF ELECTION TO RESUME PRIOR NAME
Notice is hereby given that the Plaintiff/ Defendant in the above matter,
______ prior to the entry of a Final Decree in Divorce,
or ______ after the entry of a Final Decree in Divorce dated _________________,
(select one by marking with an "x")
hereby elects to resume the prior surname of ______________________________, and gives
this written notice avowing his/her intention pursuant to the provisions of 54 P.S. § 704.
Date: ___________________________ ___________________________________
Signature
___________________________________
Signature of name being resumed
COMMONWEALTH OF PENNSYLVANIA )
) SS.
COUNTY OF DELAWARE )
On the _______________ day of ____________________, ___________, before me,
the Prothonotary or a Notary Public, personally appeared the above affiant know to me to be the
person whose name is subscribed to the within document and acknowledged that he/she
executed the foregoing for the purpose therein contained.
In Witness Whereof, I have hereunto set my hand and official seal.
__________________________
Prothonotary or Notary Public
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