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INRE:
NOTICE TO RESUME
PRIOR SURNAME
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
DORIS L. BAUGHMAN,
Surviving Spouse
; NO. ck - Sir 1 CIVIL TERM
NOTICE TO RESUME PRIOR SURNAME
Notice is hereby given that the Surviving Spouse in the above caption, having filed a
Certificate of Death for their deceased spouse, which is attached hereto, hereby elects to resume
the prior surname of DORIS L. BRANDT, and gives this written notice pursuant to the
provisions of 54 Pa, C.S.A 704.1, effective 9/6/2005. The current address for the surname to be
resumed is: 751 Baltimore Pike, Gardners, Pennsylvania 17324.
I verify that the statements made in this document are true and correct. I understand that
false statements herein made are subject to the penalties of 18 Pa.C.S. Section 4904 relating to
unsworn falsification to authorities.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 6th day of
September, 2006.
WITNESSED:
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DORIS L. BAUGHMAN
DORIS L. BRANDT
.
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
PERSONALLY APPEARED BEFORE ME, this 6th day of September, 2006, a Notary
Public, in and for the Commonwealth of Pennsylvania and County of Cumberland, DORIS L.
BAUGHMAN, known to me (or satisfactorily proven) to be the person whose name is
subscribed to the within Notice to Resume Prior Surname, and acknowledges that she executed
the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
COMMONWEALTH Of PENNSYLVANIA
NolIIIII SeIII
Mdla L Noll. NoIIIy NIIIc
CaIIIlIIIaIo. CuI.......od County
My c....,........\ I!Jpiw Sept. 18, 2llO7
Member, "'nnoytvania A'lOdation 01 Notarioa
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,This i...ro certify that the information here given is correctly copied from an original certificate of dearh duly filed with me as
Local Registrar, The original certificate will be forwarded to the State Vital Records Office for permanent filing,
WARNING: It is Illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
4817515
No,
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Local Registrar
FEll. 1 3 1998
Date
H1Q&.144......1/81
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
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Coroner
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21)""'11I',",,", Michael L. Norris, Coroner
405 Fairway Drive
Mechanicsbur , Pa. 17055
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