Complaint For Divorce Form - Sc Judicial Department Page 3

B. For an Order allowing the Plaintiff to resume the former name of

____________________________ pursuant to §20-3-180 of the Code of Laws of

South Carolina, 1976, as amended; (If no name change is requested, please leave

blank).

C. For all other just and proper relief.

I affirm under the penalties of perjury that the statements and representations in the Complaint are true.

Date: ________________________, 20____

Plaintiff’s Signature

___________________________, S.C.

Printed Name of Plaintiff

Street Address

City, State, Zip

Telephone No.

SCCA 400.02 SRL-DIV (7/2011)

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