STATE OF HAWAI`I FAMILY COURT SECOND 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 Reprographics (11/08)
Secondary
Welfare
Primary
Secondary
Welfare
DATE DATE
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COUNTY / STATE COUNTY / STATE
MATRIMONIAL ACTION INFORMATION 2F-E-100
Reset Form
MATRIMONIAL ACTION INFORMATION (Continued)
FROM MONTH/YEAR TO MONTH/YEAR DIVORCE TERMINATED BY ANNULMENT DEATH
CASE NUMBER FC-D NO.
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
Form No. 073105 Reprographics (11/08)
MATRIMONIAL ACTION INFORMATION 2F-E-100