IN THE COURT OF COMMON PLEAS OF _______________ …
IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA
CIVIL DIVISION
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|Plaintiff |: | |
|vs. |: |File No. | |
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|Defendant |: | |
NOTICE TO RESUME PRIOR SURNAME
Notice is hereby given that the Petitioner in the above matter is a SURVIVING SPOUSE, as evidenced by the attached certificate of death, and hereby elects to resume the prior surname of , and hereby gives this written notice pursuant to the provisions of 54 P.S. § 704.1.
Date: Signature
Signature of Resumed Name
COMMONWEALTH OF PENNSYLVANIA)
) SS.
COUNTY OF LEHIGH )
On the day of , , before me, a Notary Public, personally appeared the above affiant known 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.
Notary Public
(Rev.0708)
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