Free Statement of Mailing Exhibits "1" and "2" (Re: Order for Income Withholding) (Form Only) - Hawaii

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"

Reset Form

1F-P-740

EXHIBIT "1"

EXHIBIT "2"

1F-P-739