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R Or Marriage Name Applicant Intends To Resume APPLICATION/NOTICE OF RESUMPTION OF FORMER NAME Applicant's Full Name At Birth Applicant's Date Of Birth Applicant's City Of Birth Applicant's County Of Birth Applicant's State Of Birth G.S. 50-12; 101-8 TO: The Clerk Of Superior Court of the county named above. DIVORCE Resumption of maiden name, prior married name, or premarriage surname (G.S. 50-12). I am a resident of the above named county or my divorce was granted in the above named count.

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