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AS OF ocr- ;{I- ~O(J~
CASE# l'f I( %' - J ~.3 chi; J +t.rwt
HAS BEEN SCANNED.
ALL EARLIER
FILINGS TO THIS
CASE HAVE BEEN
MICROFILMED.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
~",Jido~n
~ Plaintiff
I/) Vs
. (\,cksd f~ Horlman
Defendant
FileNo. J ~3 (j; v; ( of \cr~~
IN DIVORCE
NOTICE TO RESUME PRIOR SURN.AM:E
Notice is hereby given that the Plaintiff / defendant in the above matter,
[select one by marking "x"]
_ prior to the entry of a Final Decree in Divorce, 4
. or .x... after the entry of a Final Decree inDivorce dated ~ 115/ 1 / ,
hereby elects to resume the prior surname of .3S A:::.t<~ R , and gives this
written notice avo . g his / her intention purs to the provisions of 54 P .S. 704.
Date: Oft; ::J. . I a
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF 4.rnbala.n.d.)
On the l ~ th day of A ~ U b + , 200~, before me, the Prothonotary or the
notary public, personally appeared the above affiant lmown to me to be the person whose
name is subscribed to the within document and ac1mowledged that he / she executed the
foregoing for the purpose therein contained.
In Witness "Whereof, I have hereunto set my hand hereunto set my hand and official
seal.
~
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Korl K. Warriner, Notary Public
Lemoyne Boro, Cumberland County
My Commission Expires Dec. 1, 2008
Member, Pennsylvania Association of Notaries
ProthonotaJY or Notary Public
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