Free Matrimonial Action Information (Form Only) - Hawaii

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

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MATRIMONIAL ACTION INFORMATION

1F-P-082

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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