Free Forms - Hawaii


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STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

CASE NUMBER

COMPLAINT FOR DIVORCE

FC-D NO.

This document is prepared by u Plaintiff u Attorney for Plaintiff PLAINTIFF (Your Full Name) VS. _________________________________________________
Name

_________________________________________________ _________________________________________________
Address

_________________________________________________ DEFENDANT (Your Spouse's Full Name)
City, State, Zip

_________________________________________________
Phone

I, the Plaintiff, in support of this Complaint for Divorce, allege: l. Jurisdiction: I and/or my spouse, the Defendant, have lived or have been physically present in the State of Hawai`i for a continuous period of at least six (6) months and I have lived and/or been physically present on the Island of O`ahu for a continuous period of at least three (3) months immediately preceding this application. 2. Marriage: The parties (plaintiff and spouse) are lawfully married to each other. 3. Children: a. u The parties have no children together. b. u The parties have____ (enter number) child(ren) under 18 together. c. u The parties have____ (enter number) child(ren) 18 or older together, who are dependent on them for support. d. u The parties have____ (enter number) child(ren) 18 or older together, who are not dependent on them for support. e. u Wife has ____ (enter number) child(ren) born during the marriage, not fathered by Husband. f. u Wife is pregnant. 4. Custody and Visitation: a. Legal custody of the minor child(ren) should be awarded to: u Me, Plaintiff u My spouse, Defendant u Both parties jointly b. Physical custody of the minor child(ren) should be awarded to: u Me, Plaintiff u My spouse, Defendant u Both parties jointly c. The parent not awarded physical custody should have: u Reasonable visitation u Supervised visitation u ________________ d. Child support should be awarded in accordance with the child support guidelines. 5. Division of Assets: All assets my spouse and I own should be divided in a just and equitable way. 6. Division of Debts: All debts my spouse and I owe should be divided in a just and equitable way. 7. Spousal Support (Alimony): a. u I am entitled to an order that my spouse pay spousal support (alimony) to me. b. u My spouse u is u is not entitled to an order that I pay spousal support (alimony) to him/her. 8. Grounds: Pursuant to HRS Section 580-41, I allege that the grounds for divorce are as follows (check one only): a. u The marriage is irretrievably broken. b. u The parties have lived separate and apart for a period of two (2) or more years under a decree of separation from bed and board or under a decree of separate maintenance. c. u The parties have lived separate and apart for a continuous period of two (2) or more years immediately preceding the application, there is no reasonable likelihood that cohabitation will be resumed, and it would not be harsh and oppressive to Defendant, or contrary to the public interest, to grant a divorce on this ground on the complaint of Plaintiff. It is requested of the Court: That a decree be entered granting a divorce from the bonds of matrimony and granting the relief requested above, all as alleged and as may be appropriate and in accordance with the evidence and the law, and other relief as the Court deems proper in this case. I declare, under penalty of perjury, that the statements made herein are true and correct to the best of my knowledge, information and belief.
DATE PLAINTIFF'S SIGNATURE

12/97

.

COMPLAINT FOR DIVORCE 1F-P-163

Reset Forms

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

CASE NUMBER

SUMMONS
TO ANSWER COMPLAINT
FC-D NO.

This document is prepared by

u
PLAINTIFF (Full Name) VS.

Plaintiff

u

Atty. for Plaintiff

_________________________________________________
Name

_________________________________________________ _________________________________________________
Address

_________________________________________________ DEFENDANT (Spouse's Full Name)
City, State, Zip

_________________________________________________
Phone

TO THE DEFENDANT You are hereby summoned and required to serve a written answer to the attached Complaint within 20 days after service of this Summons upon you, exclusive of the date of service. Your written answer must be filed with the Chief Clerk of this Circuit at the following location or address.

Ka`ahumanu Hale 777 Punchbowl Street Honolulu, Hawai`i 96813

A copy of your answer should also be served upon the Plaintiff's attorney, or in the event Plaintiff is not represented by an attorney, upon the Plaintiff at the address shown on the Complaint. If you fail to file your written answer within the 20-day time limit, further action may be taken in this case, including judgment for the relief demanded in the Complaint, without further notice to you.

THIS SUMMONS SHALL NOT BE PERSONALLY DELIVERED BETWEEN 10:00 P.M. AND 6:00 A.M. ON PREMISES NOT OPEN TO THE PUBLIC, UNLESS A JUDGE OF THE DISTRICT OR CIRCUIT COURTS PERMITS, IN WRITING ON THE SUMMONS, PERSONAL DELIVERY DURING THOSE HOURS. FAILURE TO OBEY THE SUMMONS MAY RESULT IN AN ENTRY OF A DEFAULT AND DEFAULT JUDGMENT AGAINST THE PERSON SUMMONED.

DATE

CLERK OF COURT

FORM NO. 073921

12/97

SUMMONS TO ANSWER COMPLAINT 1F-P-064

In accordance with the Americans with Disabilities Act and other applicable state and federal laws, if you require a reasonable accommodation for a disability, please contact the ADA Coordinator at the Family Court Administration Office at PHONE NO. 539-4400, FAX 539-4402, or TTY 539-4853, at least ten (10) working days prior to your hearing or appointment date.

STATE OF HAWAI`I FAMILY COURT FIRST CIRCUIT
PLAINTIFF

CASE NUMBER

MATRIMONIAL ACTION INFORMATION
PREPARED: PLAINTIFF DEFENDANT ATTORNEY FOR PLAINTIFF ATTORNEY FOR DEFENDANT

FC-D NO.

DATE FILED

DEFENDANT

NATURE OF CASE DIVORCE SEPARATION

ANNULMENT

OTHER

ITEM
FULL NAME BIRTH OR MAIDEN NAME ADDRESS STREET, APT. NO. TOWN, STATE, ZIP COUNTY HOME PHONE

WIFE

HUSBAND

WORK

HOME

WORK

SOCIAL SECURITY NUMBER DATE OF BIRTH PLACE OF BIRTH (State or Country) RACE HIGHEST GRADE COMPLETED HAWAII RESIDENT SINCE CIRCUIT RESIDENT SINCE PRIMARY EMPLOYER (Name and Address)

JOB TITLE WORK SCHEDULE LENGTH OF SERVICE Primary GROSS MONTHLY INCOME (All Sources) DATE OF THIS MARRIAGE DATE OF SEPARATION NOT SEPARATED
Form No. 073105 R12/97

Secondary

Welfare

Primary

Secondary

Welfare

DATE DATE

COUNTY / STATE COUNTY / STATE

(Continue on back page)

MATRIMONIAL ACTION INFORMATION

1F-P-082

MATRIMONIAL ACTION INFORMATION (Continued)

CASE NUMBER FC-D NO.

FROM MONTH/YEAR

TO MONTH/YEAR DIVORCE

TERMINATED BY ANNULMENT DEATH

STATE

WIFE'S PRIOR MARRIAGES

HUSBAND'S PRIOR MARRIAGES

CHILDREN:
CHILD'S FULL NAME

ALL CHILDREN OF EITHER PARTY FROM YOUNGEST TO OLDEST M/F BIRTHDATE LEGAL PRESENT PARENT CUSTODY (HUSBAND, WIFE OR OTHER) SCHOOL AND GRADE

INFORMATION REQUIRED FOR CUSTODY
CHILDREN'S PRESENT ADDRESS:

PLACES WHERE AND PERSONS WITH WHOM THE CHILDREN HAVE LIVED WITHIN THE LAST FIVE YEARS AND DATES ADDRESS CARETAKERS FROM MONTH/YEAR TO MONTH/YEAR

WIFE

IS

IS NOT PREGNANT. EXPECTED DELIVERY DATE:

THE UNDERSIGNED SOLEMNLY AND SINCERELY DECLARES, UNDER PENALTY OF PERJURY, THAT THE STATEMENTS MADE HEREIN ARE TRUE AND CORRECT TO THE BEST OF HIS/HER KNOWLEDGE, INFORMATION AND BELIEF.
DATE SIGNATURE

STATE OF HAWAI'I FAMILY COURT FIRST CIRCUIT
PLAINTIFF'S Name: Address: Telephone: (hm) (wk) Cellular: DEFENDANT'S Name: Address: Telephone: (hm) (wk) Cellular:

NOTICE TO ATTEND KIDS FIRST

CASE NUMBER FC-D NO.

Attorney's Name, Address and Telephone Number No Attorney

Staff Use Only Date Attended: Attorney's Name, Address and Telephone Number No Attorney

Staff Use Only Date Attended:

DO NOT BRING CHILDREN UNDER THE AGE OF 6 YEARS OLD
CHILDREN: List all children ages 6 to 17 years old from this and any prior relationship. NAME DATE OF BIRTH & AGE LIVING WITH: Mother Mother Mother Mother Mother Mother Father Father Father Father Father Father Other Other Other Other Other Other Staff Use Only (Date Attended)

Mother, Father and children, ages 6 - 17 must attend. You are scheduled for: Date: Wednesday,____________________ Time: 4:30 p.m. Registration 5:00 p.m. to 7:15 p.m. Program Place: Circuit Court Jury Pool Lounge, First Floor 777 Punchbowl Street, Honolulu, Hawai`i

IMPORTANT: READ INSTRUCTIONS on page 2 of this notice.
DATE CLERK'S SIGNATURE

Revised June 2003

Page 1 of 2

KIDS FIRST INSTRUCTIONS
KIDS FIRST is a program designed to help parents understand the effects of separation and divorce on their children and to help children cope with changes in their families. Both parents and children (ages 6 - 17) of either mother or father, from this and any prior relationships must attend Kids First, unless excused by the Judge. Failure to attend may cause you to be brought before the Court to explain your nonattendance and may be considered as a factor in custody decisions. Non-attendance may also delay the granting of your divorce decree. Your children will be escorted to the second floor of the courthouse to view a video and participate in activities and a mock trial. Children will be grouped by age and will be led by trained facilitators. Parents will have their own program presented by a Family Court Judge and psychologists who specialize in divorce. DO NOT BRING CHILDREN UNDER AGE 6 or any child not listed on page 1 of this notice. Babies and minor children are not allowed in the parents' program. If you bring a child under age 6, you will be required to reschedule to another day. Metered parking is available on the surrounding streets. (Caution: Halekauwila Street has a tow-away zone.) Also, parking is available at Restaurant Row for a reduced rate with validation. Bring the parking stub to the program for a validation. Entry to Restaurant Row parking is on Pohukaina Street or South Street. Please enter the Circuit Court through the front door at 777 Punchbowl Street. You must call (808) 538-5878 if any of the following apply: Restraining Order Moving off island Child Protective Service Case Child with special needs (physical, mental, language difficulties) You received this notice after your scheduled date Any scheduling questions Leave your name, daytime phone number/cellular number and a detailed message on this recording. Your call will be returned as soon as possible.
In accordance with the Americans with Disabilities Act and other applicable state and federal laws, if you require reasonable accommodations for a disability, please contact the Disability Accommodations Coordinator at the First Judicial Circuit, Chief Court Administrator's Office 539-4400, FAX 539-4402 or TTY 539-4853, at least ten days prior to your appointment.

Page 2 of 2

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

MOTION FOR SERVICE BY MAIL AND AFFIDAVIT; ORDER FOR SERVICE BY MAIL u
PLAINTIFF (Full Name)
Movant

CASE NUMBER FC-D NO.

This document is prepared by

u

Atty. for Movant

_________________________________________________
Name

_________________________________________________ VS. _________________________________________________
Address

_________________________________________________ DEFENDANT (Full Name)
City, State, Zip

_________________________________________________
Phone

MOTION FOR SERVICE BY MAIL AND AFFIDAVIT The undersigned party to this action moves for an order authorizing service by registered or certified mail. In support of this motion the undersigned states that to his/her best information and belief the adverse party is outside the Circuit and receives mail at the following address:

MOVANT'S SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME THIS DATE: NOTARY PUBLIC'S SIGNATURE MY COMMISSION EXPIRES:

STATE OF HAWAI`I, FIRST JUDICIAL CIRCUIT

ORDER FOR SERVICE BY MAIL
It appears that service by mail is appropriate and reasonable. IT IS HEREBY ORDERED that service herein may be made by forwarding certified copies of the u Complaint u Summons u Motion and Affidavit for Pre-Decree Relief and Attachments u Motion and Affidavit for Post-Decree Relief and Attachments u Income and Expense Statement; Asset and Debt Statement u ____________________________________________________________________ and of this Order to the u Plaintiff u Defendant by registered or certified mail with return receipt requested and a direction to deliver to addressee only and that actual receipt by the u Plaintiff u Defendant of the above document(s) sent in accordance with this Order shall be equivalent to personal service by an authorized process server as of the date of receipt.

DATE

CLERK OF THE COURT

FORM NO. 073922 (12/97)

MOTION FOR SERVICE BY MAIL AND AFFIDAVIT; ORDER FOR SERVICE BY MAIL 1F-P-186

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

CASE NUMBER

APPEARANCE AND WAIVER

FC-D NO.

This document is prepared by

u
PLAINTIFF (Full Name) VS.

Plaintiff

u

Defendant

u

Atty. for Plaintiff

u

Atty. for Defendant

_________________________________________________
Name

_________________________________________________ _________________________________________________
Address

_________________________________________________ DEFENDANT (Full Name)
City, State, Zip

_________________________________________________
Phone

I, the Defendant, acknowledge receipt of a filed copy of the Complaint and Summons in the above-entitled action, submit myself to the Court's jurisdiction, and have agreed with the Plaintiff on the matters set forth in u a signed agreement incident to divorce. u a form of Decree which I have approved by signature. I consent to a hearing of the complaint by a judge at any time without further notice and without my presence so long as the Decree issued incorporates the provisions I have approved. If such Decree is not entered by the Court, I request to be notified. I understand that I am not required to sign this paper and that by doing so I am permitting the Court without opposition from me to proceed with the above-entitled matter at this time unless there is reason for the Court to alter our agreement.

u I am not in the military service of the United States. u I am in the military service of the United States, but I do not request a stay of proceedings herein, and I do
waive any rights I may have under the Soldiers' and Sailors' Civil Relief Act, 50 U.S.C. Sec. 521, et. seq.

DATE

DEFENDANT'S SIGNATURE

12/97

APPEARANCE AND WAIVER 1F-P-332

Reset Names A&W

STATE OF HAWAI`I FAMILY COURT FIRST CIRCUIT

PROOF OF SERVICE

CASE NUMBER

FC-D NO.

This document is prepared by u Plaintiff u Attorney for Plaintiff PLAINTIFF (Full Name) VS. _________________________________________________
Name

_________________________________________________ _________________________________________________
Address

_________________________________________________ DEFENDANT (Full Name)
City, State, Zip

_________________________________________________
Phone

I served a certified copy of each document identified below by delivering to the following person(s):
PERSON(S) SERVED DATE TIME PLACE

DOCUMENTS SERVED

u Complaint u Summons u Notice to Attend Kids First II u Motion and Affidavit for Pre-Decree Relief and Attachements u Motion and Affidavit for Post-Decree Relief and Attachments u ___________________________________________
PLEASE EXPEDITE RETURN OF SERVICE TO FAMILY COURT
DATE POLICE OFFICER'S SIGNATURE BADGE ID NUMBER

DATE

OTHER SERVING OFFICER'S SIGNATURE

NAME OF SERVING OFFICER

u UNSERVED DOCUMENTS: I certify that, despite due and diligent search, I was unable to locate the person to be served, and therefore the attached documents are being returned as unserved.

FORM NO. 073918

(12/98)

PROOF OF SERVICE 1F-P-140

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

CASE NUMBER

STATEMENT OF MAILING EXHIBITS "1" AND "2" u u

FC-D NO.

This document is prepared by
Plaintiff Atty. for Plaintiff

PLAINTIFF (Full Name) VS.

_________________________________________________
Name

_________________________________________________ _________________________________________________
Address

_________________________________________________ DEFENDANT (Full Name)
City, State, Zip

_________________________________________________
Phone

STATEMENT OF MAILING
I REPRESENT THAT I caused one certified copy each of the Complaint For Divorce; Summons to Answer Complaint; and Motion for Service by Mail and Affidavit; Order for Service by Mail; and _________________________________, to be mailed by certified or registered mail, return receipt requested, restricted delivery to: _________________________________________________________________________________
Defendant's Name

_________________________________________________________________________________
Defendant's Address

_________________________________________________________________________________
City/State/Zip

Defendant At the time of mailing, the receipt attached hereto as Exhibit "1" was postmarked and dated. Thereafter, the return receipt attached as Exhibit "2" was received.

DATE

PLAINTIFF'S SIGNATURE

4/98

STATEMENT OF MAILING/EXHIBITS "1" AND "2" 1F-P-3XX

EXHIBIT "1"

EXHIBIT "2"

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

CASE NUMBER

INCOME AND EXPENSE STATEMENT u Plaintiff u Defendant u
PLAINTIFF (Full Name)

FC-D NO.

This document is prepared by
Plaintiff

u

Defendant

u

Atty. for Plaintiff

u

Atty. for Defendant

_________________________________________________
Name

_________________________________________________ VS. _________________________________________________
Address

_________________________________________________ DEFENDANT (Full Name)
City, State, Zip

_________________________________________________
Phone

Occupation: _________________________________________________________________________________ Job title Employer: __________________________________________________________________________________ Address: ___________________________________________________________________________________ Length of service: _____________ months/years. Income Tax Withholding based on: ________ dependents. INCOME Gross income. Paid: monthly, 2 times per month, every 2 weeks, weekly or other ___________

Gross per pay period ...................................... $ ___________ Payroll deductions per pay period:

Per month ............................... $ ____________

Fed. income tax ....................................... $ ____________ State income tax ...................................... $ ____________ FICA (Social Security) ............................ $ ____________ Union dues .............................................. $ ____________ a) Net per pay period ................... $ ___________ Per month ........ $ _____________ Other: Retirement/401K ................................... $ ____________ Credit Union .......................................... $ ____________ Direct Deposit ....................................... $ ____________ Income Assignments.............................. $ ____________ Support Payments .................................. $ ____________ Medical Insurance ................................. $ ____________ b) Take home per pay period ....... $ ___________ Per month ........ $ _____________ Other regular monthly income, (rental income, 2nd job, interest, child support, welfare, food stamps, and any other source.) Gross monthly receipt ............................. $ ____________ Taxes paid IRS and State on above .......... $ ____________ c) Total other income net ............................... $ ____________ Total Monthly Income (Add per month income from lines a and c above) $ _____________
FORM NO. 073917 R12/97 INCOME & EXPENSE STATEMENT 1F-P-081

Reset Names I&E

EXPENSES Do not list expenses which are paid by payroll deduction. Housing, expenses per month: rent, mortgage, agreement of sale ................................ insurance if not included above.................................... Real Property taxes (if paid separately) ........................ Utilities, gas, water, elec., telephone etc. ...................... Transportation, expenses per month: Car payment, lease, rental ............................................ Insurance on vehicle .................................................... Maintenance (repairs) .................................................. Operating (gas, oil & tires) .......................................... $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________

Total Housing and Transportation expenses ..................................................................................... $ ____________ Debt service (all monthly payments, eg. credit cards, charges, finance company, personal loans)...... $ ____________ Personal Expenses per month: Self Food ............................................................................... $ ____________ Clothing ......................................................................... $ ____________ Medical and Dental ........................................................ $ ____________ Laundry & Cleaning ....................................................... $ ____________ Personal articles ............................................................. $ ____________ Recreation (movies etc) .................................................. $ ____________ School (include food) ..................................................... $ ____________ Household ...................................................................... $ ____________ Bus (on monthly basis) ................................................... $ ____________ Other (_____________________) .................................. $ ____________ Payment to others for dependent care ......................................................... Sub Totals .......................................................... $ ____________ Total Personal expenses................................................................................$ ___________ Grand Total expenses: Housing, Trans., Debt & personal .......................................................... $ ____________ Savings, : Income minus Expenses ....................................................................... $ ____________ Explain in detail where savings are invested, or if there is a , who provides the funds to maintain the level of spending indicated in this income and expense statement. (Use separate sheet if more space is needed.) __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ CERTIFICATION I hereby declare under the penalty of perjury that I have supplied the information used in this Income and Expense Statement and have reviewed this statement and I certify that the information is accurate, complete and correct.
DATE

Children No.( _ ) $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________

u

PLAINTIFF'S u DEFENDANT'S SIGNATURE

FORM NO. 073917 R12/97

INCOME & EXPENSE STATEMENT 1F-P-081

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

CASE NUMBER

ASSET AND DEBT STATEMENT u Plaintiff u Defendant u Both Parties u
PLAINTIFF (Full Name)
Plaintiff

FC-D NO.

This document is prepared by

u

Defendant

u

Atty. for Plaintiff

u

Atty. for Defendant

_________________________________________________
Name

_________________________________________________ VS. _________________________________________________
Address

_________________________________________________ DEFENDANT (Full Name)
City, State, Zip

_________________________________________________
Phone

1. Cash (on hand or held by others for me) 2. CREDIT UNION ACCOUNTS:
Name Title (H,W,J)

$ ______________________________________

Credit Balance

Debt Balance

___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

3. BANK AND SAVINGS ACCOUNTS:
Company & Branch

(Include Trustee Accounts)
Title (H,W,J) Current Balance

Type of Account

___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

4. SECURITIES:
Company

(Stocks, Bonds, Mutual Funds, Certificates of Deposit, etc.)
Title (H,W,J) Date of Acquisition Cost Market Value Debt Owed Against

___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

Form No. 073925 R12/97

ASSET AND DEBT STATEMENT 1F-P-063

Reset Names A&D

Page 2 5. VEHICLES:
Year

(Autos, Trucks, Motorcycles, Trailers, Campers, Boats, etc.)
Make Title (H,W,J) Currrent Market Value Debt Owed Against

___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

6. REAL PROPERTY:
Address Fee or Lease Tltle (H,W,J) Date of Acquisition Cost Current Gross Value Total Debt Owed

___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

7. LIFE INSURANCE:
Company Person Insured Face Amount Beneficiary Title (H,W,J) Cash Value Debt Owed Against

___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

8. RETIREMENT; PENSION; PROFIT SHARING ACCOUNTS:
Employer or Company Title (H,W,J) Type of Plan Years in Plan Total Value

___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

9. ALL OTHER MAJOR ASSETS: (Furniture, Household Effects, Art, Stamps, Coins, Tools, Equipment, Jewelry, Accounts Receivable, Investment Assets, Business Assets, Cemetary Plots or Niches, Tax Refunds Due, etc.)
General Description Title (H,W,J) Estimated Gross Value Debt Owed Against

___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

Form No. 073925 R12/97

ASSET AND DEBT STATEMENT 1F-P-063

Page 3 10. PROPERTY HELD IN TRUST FOR OR BY THIRD PERSON/S: (Aside from Bank & Savings Accounts Noted in paragraph 3)
Description Trustee/s Beneficiaries Value Debt Owed Against

___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

11. ALL OUTSTANDING DEBTS: (Include those listed parts in 2, 4, 5, 6, 7, 9, and 10 above, in addition to all credit cards, charges, finance companies, and personal loans.)
Creditor Debtor (H,W,J or Other) Security Mo./Yr. Debt Incurred Total Balance Owed Minimum Monthly Payment

___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

Total Debt in Wife's Name Alone: ______________________________________________________________________________ Total Debt in Husband's Name Alone:
_________________________________________________________________________

Total Debt in Joint Names: ______________________________________________________________________________________

CERTIFICATION I hereby declare under the penalty of perjury that I have supplied the information used in this Asset and Debt Statement and have reviewed this statement and I certify that the information is accurate, complete and correct.
DATE

u

PLAINTIFF'S u DEFENDANT'S SIGNATURE

DATE

u

PLAINTIFF'S u DEFENDANT'S SIGNATURE

Form No. 073925 R12/97

ASSET AND DEBT STATEMENT 1F-P-063

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

CASE NUMBER

AFFIDAVIT OF PLAINTIFF (FOR UNCONTESTED DIVORCE) u
PLAINTIFF (Your Full Name)

FC-D NO.

This document is prepared by
Plaintiff

u

Atty. for Plaintiff

_________________________________________________
Name

_________________________________________________ VS. _________________________________________________
Address

_________________________________________________ DEFENDANT (Your Spouse's Full Name)
City, State, Zip

_________________________________________________
Phone

STATE OF HAWAI`I CITY AND COUNTY OF HONOLULU

) ) )

SS.

Plaintiff in the above-entitled action, being first duly sworn on oath, deposes and says that: 1. Plaintiff's full name and address is: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 2. Legal Representation: 2a. u Plaintiff is representing him/herself. 2b. u Plaintiff is represented by the attorney named above. 3. Service of process on Defendant was made by: 3a. u Personal Service: A Proof of Service or Affidavit of Service has been filed showing that the Defendant was personally served with the Complaint and Summons on _______________________ by a person (Mo/Day/Yr) authorized to serve of legal documents. 3b. u Certified or Registered Mail: The Complaint and Summons was served upon Defendant by certified or registered mail. A Statement of Mailing or Affidavit of Mailing and an original return receipt signed by the Defendant on ________________ have been filed. Plaintiff recognizes Defendant's signature on the return (Mo/Day/Yr) receipt. 3c. u Appearance and Waiver: Defendant acknowledged receipt of a filed copy of the Complaint and Summons and signed an Appearance and Waiver on ______________________. Plaintiff recognizes Defendant's (Mo/Day/Yr) signature on the Appearance and Waiver. 3d. u Publication: The Affidavit of Publication was filed on _________________.
(Mo/Day/Yr)

4. u Default. 4a. u More than twenty (20) days have passed since the service of the Complaint and Summons on the Defendant. No responsive pleading has been filed. Neither Plaintiff nor Plaintiff's attorney has received any communication from Defendant or Defendant's attorney concerning this case since the Complaint was served. 4b. u An order granting the Motion for Entry of Default was filed on___________________.
(Mo/Day/Yr)

12/98

AFFIDAVIT OF PLAINTIFF (UDA) 1F-P-333

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

AFFIDAVIT OF PLAINTIFF (FOR UNCONTESTED DIVORCE) PAGE TWO

CASE NUMBER FC-D NO.

5. Jurisdiction: (Check all that apply) 5a. u Plaintiff had been domiciled or physically present on the Island of O`ahu for a continuous period of at least 3 months prior to the filing of the Complaint for Divorce. 5b. u Plaintiff had been domiciled or physically present in the State of Hawai`i for a continuous period of at least 6 months prior to the filing of the Complaint for Divorce. 5c. u Defendant had been domiciled or physically present in the State of Hawai`i for a continuous period of at least 6 months prior to the filing of the Complaint for Divorce. 6. Defendant resides in (city, state) _______________________________ , _______________________________ .
(City) (State)

7. The parties were married on _______________________________ .
(Mo/Day/Yr)

8. The parties last lived together in (city, state) ___________________________ , ________________________ on (City) (State) _____________________________________ .
(Mo/Day/Yr)

9. Plaintiff believes that the marriage is irretrievably broken because: __________________________________________________________________________________________ __________________________________________________________________________________________ 10. Financial statements: 10a. Plaintiff signed Income and Expense and Asset and Debt Statements on _______________________. To the (Mo/Day/Yr) best of Plaintiff's knowledge there have been no substantial changes in Plaintiff's financial circumstances since that date. 10b. u Defendant signed Income and Expense and Asset and Debt Statements on _______________________. (Mo/Day/Yr) Plaintiff recognizes Defendant's signature on said documents. 10c. u Defendant's Income and Expense Statement and Asset and Debt Statement are not filed because: _______________________________________________________________________________________ _______________________________________________________________________________________ 11. Plaintiff has carefully reviewed the proposed decree and agrees to the alimony, division of property and other provisions as provided in the proposed decree. 12. Plaintiff signed the proposed decree. u Plaintiff recognizes Defendant's signature on the decree. 13. Wife wishes to resume the use of her u birth surname u former married name and be known as: __________________________________________________________________________________________ . 14. Husband wishes to resume the use of his u birth surname u former married name and be known as: __________________________________________________________________________________________ . 15. Language Comprehension: 15a. u Plaintiff fully understands the English language. 15b. u Although Plaintiff does not fully comprehend written English, this document has been explained to him/ her by ____________________ and based on that explanation Plaintiff understands this document. 16. Plaintiff requests that the court grant this divorce and enter the decree without his/her appearance in court. 17. Plaintiff has read this document and signs it voluntarily and without coercion and duress and not because he/she was told to sign it.
12/98

Page 2 of 4

AFFIDAVIT OF PLAINTIFF (UDA) 1F-P-333

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

AFFIDAVIT OF PLAINTIFF (FOR UNCONTESTED DIVORCE) PAGE THREE

CASE NUMBER FC-D NO.

18. Pregnancy: 18a. u Wife is not pregnant. 18b. u Wife is pregnant and her expected date of delivery is _______________. Husband u is u is not the father (Mo/Day/Yr) of said child. 19. Child(ren): 19a. u Plaintiff and Defendant have no children together. 19b. u The parties have ______ children together. The complete name and birthdate of each are listed as follows from the oldest to the youngest child (including adult child(ren)): Name Date of Birth

__________________________________________________________________________________________ (Mo/Day/Yr) __________________________________________________________________________________________ (Mo/Day/Yr) __________________________________________________________________________________________ (Mo/Day/Yr) __________________________________________________________________________________________ (Mo/Day/Yr) __________________________________________________________________________________________ (Mo/Day/Yr) __________________________________________________________________________________________ (Mo/Day/Yr) 19c. u There is/are child(ren) conceived during the marriage fathered by someone other than husband. Their name(s) and date of birth is/are listed as follows: Name Date of Birth Judgment of Paternity entered

u Yes _____________________________________________________________ (Mo/Day/Yr) u Yes _____________________________________________________________ (Mo/Day/Yr)

u No u No

20. Prior or Pending Custody Proceedings: 20a. u I have not participated in any capacity in any law suit or proceeding in any state concerning custody of any of the minor children of the Plaintiff and Defendant together. I have no information of any pending custody proceeding or of any person not a party to this proceeding who has physical custody or claims to have custody or visitation rights concerning any minor children of the Plaintiiff and Defendant together. 20b. u Prior court case involving the subject children: Case Name: __________________________________________________________________________ Case Number: ________________________________________________________________________ Location of Court:_____________________________________________________________________ Date Filed: (Mo/Day/Yr) __________________________________________________________________________ Date Concluded: (Mo/Day/Yr) ______________________________________________________________________ Type of Case: ________________________________________________________________________ 20c. u Other court case involving the subject children which is still pending: Case Name: __________________________________________________________________________ Case Number: ________________________________________________________________________ Location of Court:_____________________________________________________________________ Date Filed: (Mo/Day/Yr) __________________________________________________________________________ Date Concluded: (Mo/Day/Yr) ______________________________________________________________________ Type of Case: ________________________________________________________________________

12/98

Page 3 of 4

AFFIDAVIT OF PLAINTIFF (UDA) 1F-P-333

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

AFFIDAVIT OF PLAINTIFF (FOR UNCONTESTED DIVORCE) PAGE FOUR

CASE NUMBER FC-D NO.

21. u Plaintiff agrees to the custody arrangement and child support amounts as provided in the proposed divorce decree. 22. Child Support: 22a. u Plaintiff believes that the information provided in the completed Child Support Guildelines Worksheet is accurate, to the best of the Plaintiff's knowledge and proposed child support is consistent with the Child Support Guidelines Worksheet. 22b. u Proposed child support varies from the Child Support Guidelines Worksheet because of the following exceptional circumstances: ______________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 23. Kids First: (Mo/Day/Yr) 23a. u I attended the Kids First II Program (Wednesday Night) on ____________________________________ . 23b. u I was excused by Judge _______________________________ from attending the Kids First II Program. 24. u Other: __________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________
Plaintiff declares that he/she understands that his/her signature under oath before a notary public is his/her solemn statement that he/she read this Affidavit and knows and understands the contents and that these statements are true, correct and complete to the best of his/her knowledge and belief.

PLAINTIFF'S SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME THIS DATE: NOTARY PUBLIC'S SIGNATURE MY COMMISSION EXPIRES:

IN___________________, Hawai`i
12/98

STATE OF HAWAI`I
Page 4 of 4
AFFIDAVIT OF PLAINTIFF (UDA) 1F-P-333

FAMILY COURT FIRST CIRCUIT STATE OF HAWAI`I

SUPPLEMENTAL AFFIDAVIT RE: DIRECT PAYMENT CHILD SUPPORT
PLAINTIFF,

CASE NUMBER FC-D NO.

Preparer's Name, Address and Telephone Number

vs.

DEFENDANT.

1.

My spouse and I have agreed that I shall pay child support directly to my spouse and not through the Child Support Enforcement Agency (CSEA). Such an arrangement is in the best interest of our child(ren) because:

2.

3.

[ ] I affirm that all prior child support, ordered by the court or administratively, has been paid in a timely fashion. I have not been previously ordered to pay child support. [ ] Our child(ren) do/does not receive public assistance, welfare, foster care, Social Security or other governmental assistance. There are no outstanding debts owed to the Department of Human Services or other public assistance agencies by myself or my spouse. I understand that at any time after the entry of our Divorce Decree, either party may void the direct payment arrangement and apply for services from the Child Support Enforcement Agency (CSEA) to receive payment through the agency. I further understand that if our child(ren) receive(s) public assistance from the Department of Human Services, foster care payments or Social Security or if either parent applies to the CSEA for services, CSEA may immediately void the direct payment arrangement by sending written notice by regular mail to both parents at their last known addresses as set forth in our Divorce Decree or subsequent child support order. Based upon the facts set forth herein, I ask this Court to approve direct payments of child support rather than requiring that child support payments be made through the CSEA.

4.

5.

6.

7.

8.

I declare that I understand that my signature under oath before a notary public is my solemn statement that I have read this affidavit and I know and understand the contents and that the statements are true, correct and complete to the best of my knowledge and belief. SIGNATURE

SUBSCRIBED AND SWORN TO BEFORE ME ON THIS DATE:

NOTARY PUBLIC'S SIGNATURE

MY COMMISSION EXPIRES:

STATE OF HAWAI`I dirpay.aff - 11/98

FOR COURT USE ONLY

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

CASE NUMBER

DIVORCE DECREE (With Children) u
PLAINTIFF (Full Name)
Plaintiff

FC-D NO.

This document is prepared by

u

Defendant

u

Atty. for Plaintiff

u

Atty. for Defendant

_________________________________________________
Name

_________________________________________________ VS. _________________________________________________
Address

_________________________________________________ DEFENDANT (Full Name)
Presiding Judge
City, State, Zip

_________________________________________________
Phone

Date of Hearing/Review by Judge

A hearing was held before the Presiding Judge or an affidavit was submitted and the Court waived hearing on this matter. After full consideration of the evidence, the Court finds the material allegations of the Complaint for Divorce to be true. Plaintiff is entitled to a divorce from the bonds of matrimony. The Court has jurisdiction to enter this Divorce Decree. In this Divorce Decree, Plaintiff is referred to as u Husband u Wife, and Defendant is referred to as u Husband u Wife. IT IS HEREBY ORDERED, ADJUDGED AND DECREED that: 1. Decree: A decree of divorce is granted to u Husband u Wife. The bonds of matrimony between Husband and Wife are hereby dissolved. The parties are restored to the status of single persons. Either party is permitted to marry after the effective date of this Divorce Decree. 2. Effective Date: This Divorce Decree is effective after it is signed and filed by the Court. 3. Alimony: u 3A. Neither party shall be required to pay alimony to the other party. (Month/Year) u 3B. Beginning with a first payment on the _____ day of ____________________________________________________ u Husband u Wife shall pay to u Husband u Wife alimony of $________________ per month, to be paid u in one amount of $___________by the _____ day of each month. u in two equal installments of $___________ by the _____ and _______ days of each month. (Mo/Day/Yr) Alimony shall continue for ____ months and terminate with the payment due _______________________________ . Alimony shall terminate upon the death of either Husband or Wife. Alimony u shall u shall not terminate upon the recipient's remarriage. 4. The parties have _____ child(ren) together: Name (first, middle, last) Date of Birth _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 5. Custody: 5A. Legal Custody of the above-named minor child(ren) is: u Awarded to Husband u Awarded to Wife u Awarded to Husband and Wife, jointly. u Reserved for a court of competent jurisdiction.

FORM NO. 073106

8/98

(Page 1)

DIVORCE DECREE (WITH CHILDREN) 1F-P-096

Reset Names

5B.

u Awarded to Husband with a detailed visitation/time sharing schedule to Wife as described in paragraph 6. u Awarded to Wife with a detailed visitation/time sharing schedule to Husband as described paragraph 6. u Awarded to Husband and Wife, jointly, with a visitation/time sharing schedule as described in paragraph 6B below. u Reserved for a court of competent jurisdiction.

Physical Custody of the above-named minor child(ren) is:

6. Visitation/Time Sharing Schedule shall be as follows: u 6A. The parties shall arrange reasonable visitation. u 6B. Visitation/time sharing schedule shall be as follows: ____________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . u 6C. Supervised visitation: ____________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . u 6D. There shall be no visitation until further order of the Family Court. X 7. u Unless specified in paragraph 24 of this decree, Husband and Wife shall keep each other informed of his/her residence address and telephone number for so long as any child of the parties is a minor and for so long thereafter as there is a support order. 8. Child Support: u 8A. Beginning with the first payment on the _______ day of_____________________, Husband shall pay to Wife for the support of the parties' child(ren) $ __________ per child, for a total of $ ____________ per month. u 8B. Beginning with the first payment on the_______ day of_____________________, Wife shall pay to Husband for the support of the parties' child(ren) $ __________ per child, for a total of $ ____________ per month. u 8C. Child support is reserved for a court of competent jurisdiction. X u 8D. Payments of child support shall continue for each child until the child attains the age of eighteen years, or graduates from high school, or discontinues high school, whichever occurs last. Child support shall further continue uninterrupted (including during regular school vacation periods) until the age of 23 as long as the child continues his or her education post-high school on a full-time basis at an accredited college or university or in a vocational or trade school. X u 8E. The Child Support Enforcement Agency (CSEA) is made a party for the limited issue of child support. 9. Method of Child Support Payment ( Check either 9a OR 9b): u 9A. All payments shall be made payable to and through the Child Support Enforcement Agency (CSEA), P.O. Box 1860, Honolulu, Hawai'i 96805-1860, and pursuant to the Order of Income Withholding which shall be filed with this decree. u 9B. Direct Payment u Child support payments shall be paid by Husband directly to Wife. u Child support payments shall be paid by Wife directly to Husband. X In all direct payment cases, either Husband or Wife may void the direct payment arrangement at any time and apply u for services from the CSEA to receive payments through the agency. If the child(ren) of the parties receive(s) public assistance from the Department of Human Services, foster care payments or Social Security or if either parent applies to the CSEA, CSEA may immediately void a direct payment arrangement by sending notice by regular mail to both parents at their last known addresses as set forth in this Divorce Decree. 10. Post-High School Education Support: u 10A. Husband shall pay ____% and Wife shall pay ____% of the educational expenses of the child(ren) for so long as the child(ren) is/are a full-time student at an accredited college or university or vocational or trade school and under the age of 23.
FORM NO. 073106 8/98 DIVORCE DECREE (WITH CHILDREN) 1F-P-096

(Page 2)

u 10B. For payment of expenses related to the child(ren) attending private school see paragraph 24 below. X u 10C. For these purposes, educational expenses shall be defined to include tuition, fees and the costs of necessary books and other
course materials. 11. Child Health Care: For so long as Husband or Wife has an obligation to pay child support and/or educational support: u 11A. Husband shall maintain medical and dental insurance for the benefit of the child(ren). u 11B. Wife shall maintain medical and dental insurance for the benefit of the child(ren). u 11C. Husband shall pay the medical and dental expenses of the child(ren) not paid by insurance up to $_________________ per calendar year. Any additional medical and dental expenses not covered by insurance shall be paid ____ % by Husband and ____ % by Wife. u 11D. Wife shall pay the medical and dental expenses of the child(ren) not paid by insurance up to $_________________ per calendar year. Any additional medical and dental expenses not covered by insurance shall be paid ____ % by Husband and ____ % by Wife. 12. Life Insurance for the Benefit of Child(ren): u 12A. Husband shall maintain life insurance on his life with a minimum death benefit of $ __________ for the benefit of the child(ren) so long as there is a child support and/or educational support obligation. u 12B. Wife shall maintain life insurance on her life with a minimum death benefit of $ __________ for the benefit of the child(ren) so long as there is a child support and/or educational support obligation. X u 12C. If Husband or Wife dies without the required insurance, Husband's or Wife's estate shall be liable to the child(ren) to the extent that the required insurance was not maintained. Such obligation on the part of Husband's or Wife's estate shall be accorded the highest possible priority. X 13. u All provisions in paragraphs 3, 5, 6, 7, 8, 9, 10, 11 and 12 are subject to further order of the court.

14. Bank Savings, Checking, Credit Union Accounts and Securities (Stocks, Bonds, Mutual Funds, etc.): u 14A. There are none. u 14B. Each is awarded those titled in their name alone. u 14C. Husband is awarded: _____________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . u 14D. Wife is awarded: ________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . 15. Vehicles (Autos, Trucks, Motorcycles, Trailers, Campers, Boats, etc.): u 15A. There are none. u 15B. Each party is awarded the vehicles titled in their name alone. u 15C. Husband is awarded: _____________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . u 15D. Wife is awarded: ________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . X u 15E. Necessary transfer documents shall be signed no later than ten days following the filing of this Divorce Decree. If either party fails to do so, the Director of Finance of the City and County of Honolulu is authorized and directed to transfer the ownership of vehicle(s) if requested to do so.

FORM NO. 073106

8/98

(Page 3)

DIVORCE DECREE (WITH CHILDREN) 1F-P-096

16. Real Property: u 16A. Neither party owns any interest of any kind in any real property. u 16B. The real property shall be divided as follows: _________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . 17. Life Insurance: u 17A. There is none. u 17B. Each party is awarded the life insurance policy(ies) now held on his/her life, together with any cash value therein and subject to any debt thereon. u 17C. The life insurance shall be divided as follows: _________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . 18. Retirement Accounts/Benefits: u 18A. There are none. u 18B. Each party shall keep their own. u 18C. The retirement accounts/benefits of the parties shall be divided as follows: __________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . 19. All Other Assets (Personal Belongings, Furniture, Household Effects, Art, Stamps, Coins, Tools, Equipment, Jewelry, Accounts Receivable, Investment Assets, Business Assets, Cemetary Plots or Niches, Tax Refunds Due, etc.): u 19A. Each party is awarded the personal belongings and the household effects in his/her possession. u 19B. Husband is awarded: _____________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . u 19C. Wife is awarded: ________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . 20. All Outstanding Debts: u 20A. Each party shall pay all of the credit card and other debt, if any, now in his/her name alone. u 20B. There are no joint debts. u 20C. Husband shall pay: ______________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . u 20D. Wife shall pay: _________________________________________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________ . 21. Name Change: u 21A. Wife shall resume the use of her u birth surname u former married name and shall be known hereafter as (first, middle, last name) ____________________________________________________________________________________________ . u 21B. Husband shall resume the use of his u birth surname u former married name and shall be known hereafter as (first, middle, last name) ____________________________________________________________________________________________ . 22. u There is a supplemental order filed concurrently with this Divorce Decree.
FORM NO. 073106 8/98

(Page 4)

DIVORCE DECREE (WITH CHILDREN) 1F-P-096

23. u Failure of Party to Perform: If either party fails to execute any document in compliance with this decree, the other party may submit a motion to the Court, requesting that the Court appoint the Chief Clerk of the Court to execute said document on behalf of the non-compliant party. Said motion may be done without further notice to the non-compliant party. Such execution by the Chief Clerk shall have the same effect as if executed by the non-compliant party. 24. Other:

Date

Judge

APPROVED AS TO FORM AND CONTENT:

X

__________________________________________ Signature of Plaintiff SS#: ______________________________________ Address: ___________________________________ __________________________________________ Employer's Name and Address: _________________ __________________________________________ __________________________________________ Date Plaintiff Signed Decree: ___________________

X __________________________________________ Signature of Defendant SS# ______________________________________ Address: __________________________________ __________________________________________ Employer's Name and Address: ________________ __________________________________________ __________________________________________ Date Defendant Signed Decree: ________________

APPROVED AS TO FORM:

X

__________________________________________ Signature of Attorney for Plaintiff Name: _____________________________________

X __________________________________________ Signature of Attorney for Defendant Name: ____________________________________

FORM NO. 073106

8/98

(Page 5)

DIVORCE DECREE (WITH CHILDREN) 1F-P-096

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

CASE NUMBER

ORDER FOR INCOME WITHHOLDING

FC-D NO.

Preparer's Name, Address and Telephone Number PLAINTIFF,

VS. Hearing Date: Judge: Date Support Order Filed:

DEFENDANT.

TO THE EMPLOYER OR SUCCESSOR EMPLOYER OF: Employee/Obligor: Address: Social Security Number: IT IS HEREBY ORDERED that: I. Pursuant to Hawai`i Revised Statutes (HRS) 571-52.2 and 52.3, the employer or successor employer shall: A. Withhold from any salary, wages or any entitlement of money payable to the above employee/obligor, the amount of $_____________ per month. The amount to be withheld may be apportioned from each pay period in the month. The withholding, including a $2.00 administrative fee charged to the employee/obligor, shall not exceed the maximum permitted by section 303(b) Consumer Credit Protection Act (15 USC 1673(b)); B. Begin withholding the above amount no later than the first pay period within seven (7) days after a certified copy of this order is mailed to the employer. C. Deliver the withheld amount payable to the Child Support Enforcement Agency (CSEA), P.O. Box 1860, Honolulu, Hawai`i 96805-1860 no later than five (5) business days after the employee/obligor has been paid. If employer is ordered to withhold amounts for more than one employee/obligor, the total withholdings may be paid in one check with a list of amounts applicable to each employee/obligor by case number, name and social security number. II. The employer is notified that: A. It may charge the employee/obligor a $2.00 administrative fee for each payment made to CSEA. Said fee shall not be deducted from the amount paid the CSEA (HRS 571-52.2(f)); B. This withholding order has priority over any other garnishment, attachment, execution or assignment and is not subject to exemptions or restriction s under HRS Chapter 651, 652 and 653 (HRS 571-52.2(f)); C. It is unlawful for an employer to ignore this order. Failure to comply with this order will result in the employer being responsible for the full amount ordered to be withheld (HRS 571-52.2(g)); D. It is a crime for an employer to refuse to hire, discharge or discipline a (prospective) employee/obligor due in any part to this order. (HRS 571-52(c), 710-1077(1)(g), 706-640, and 706-663. Penalties include imprisonment and fines.

REVISED 2/99

ORDER FOR INCOME WITHHOLDING

STATE OF HAWAI`I
FAMILY COURT FIRST CIRCUIT

STATEMENT OF MAILING EXHIBITS "1" AND "2" (Re: Order for Income Withholding) u
Plaintiff

CASE NUMBER FC-D NO.

This document is prepared by

u

Atty. for Plaintiff

PLAINTIFF (Full Name) VS.

_________________________________________________
Name

_________________________________________________ _________________________________________________
Address

_________________________________________________ DEFENDANT (Full Name)
City, State, Zip

_________________________________________________
Phone

STATEMENT OF MAILING
I REPRESENT THAT I caused one certified copy of the Order for Income Withholding to be mailed by certified or registered mail, return receipt requested to:

_________________________________________________________________________________
Child Support Payor's Employer Employer's Address City/State/Zip

_________________________________________________________________________________ _________________________________________________________________________________

At the time of mailing, the receipt attached hereto as Exhibit "1" was postmarked and dated. Thereafter, the return receipt attached as Exhibit "2" was received.

DATE

PLAINTIFF'S SIGNATURE

11/98

STATEMENT OF MAILING/EXHIBITS "1" AND "2" 1F-P-3XX

EXHIBIT "1"

EXHIBIT "2"