Notice To Resume Prior Surname (Death) {Y-3F-1}

IN THE COURT OF COMMON PLEAS OF _______________ COUNTY, PENNSYLVANIA CIVIL DIVISION IN RE: NAME CHANGE OF SURVIVING SPOUSE : : : : : : File No.___________________________ NOTICE TO RESUME PRIOR SURNAME Notice is hereby given that ______________________________________________, (Name) a surviving spouse of ___________________________________________ elects to resume (Decedent) the prior surname of _____________________________________________, and gives this written notice avowing his / her intention pursuant to the provisions of 54 P.S. § 704.1. Date: ________________ _____________________________________ Signature ____________________________________ Signature of name being resumed (Note: This notice must be accompanied by an original certificate of death for the decedent.) Y-3F-1 (4/05) American LegalNet, Inc. www.FormsWorkflow.com