STATE OF HAWAI`I FAMILY COURT SECOND CIRCUIT
CASE NUMBER
STATEMENT OF MAILING EXHIBIT "1" AND "2"
PLAINTIFF, (Full Name)
FC-D NO.
This document is prepared by: Plaintiff Attorney for Plaintiff
_________________________________________________ Name _________________________________________________ _________________________________________________ Address _________________________________________________ City, State, Zip Code _________________________________________________ Telephone Number
vs.
DEFENDANT. (Full Name)
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 Code: ______________________________________________________________________________
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.
EXHIBIT "1"
EXHIBIT "2"
DATE
PLAINTIFF'S SIGNATURE
Reprographics (01/09)
STATEMENT OF MAILING; EXHIBIT "1" AND "2" 2F-E-298
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