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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
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Plaintiff 1, r V i / ~~j
• File No. 3
vs. IN DIVORCE
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Defendant
NOTICE TO RESUME PRIOR SURNAME
Notice is hereby given that the Plaintiff/Defendant in the
above matter, ha/~vling been granted a Final Decree in Divorce on the
~~ day of ~Q ~Z°/1?~eY, 19 ~ / hereby elects to resume the
prior surname of ~~ rn ~1~I ~! ~ ~ >~rs~er
and gives
this written notice pursuant to the provisions of 54 P.S. S 704.
DATE : ~! - ~ - ~~
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Si nature -
Sig ature of n e being resumed
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND SS.
O n t he ~`~-- day o f ~!/lA~ti~
Notary Public, personall a before me, a
be the person whose nameyispsubscribed tootheawithin do ument andto
acknowledged that he/she executed the foregoing for the purpose
therein contained.
In Witness Whereof, I have hereunto set my hand and official
seal.
NOTARIAL SEAL
PATRICIA A. SFiATTJ, ~iotary Public
CarlislR Boro, uumberland County
My Commissian ~x~ctrs Oa~cember 17, 2001
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