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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
Plaintiff
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vs.
Defendant
File No. `~q~ ~ ,,, I ~~4~
IN DIVORCE
NOTICE TO RESUME PRIOR SURNAME
Notice is hereby given that the Plaintiff/Defendant in the
above matter, having been granted a Final Decree in Divorce on the
~,_ day of hereby elects to resume the
prior surname of ` and gives
this written notice pursuant the pr isions of 54 P_S. S 704.
DATE:
Sign ture ~~
c^
Signature of ame being ~ umed
COMMONWEALTH OF PENNSYLVANIA:
SS.
COUNTY OF CUMBERLAND ,
On the ~~ day of ~ n Z~cS~ before me, a
Notary Public, personally appeared the above afEiant 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.
'ic_..N IAL ~
CLAUDiIA~t.: ®RE~1BP~(
Carlisle Boro, Cumberland County
My Commission Expires April 4, 2005
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