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(Name) a surviving spouse of. Signature of name being resumed.I have received an absolute divorce from my spouse and pursuant to G.S. 50-12 give notice of my intention to resume use of: my maiden name. Box 17: Print your spouse's name exactly as you wrote in on Form 1. The Notary Public will complete the rest of this form. Microsoft Word - Notice to Resume prior Surname Blank. In RE: Click here to enter text. This form is used to change a Survivor Benefit Plan election. The surviving spouse should complete the name and Social Security number section of the return as the primary taxpayer on the return. Form 15 Notice of Intention to Resume Prior Surname.