Free Affidavit of Plaintiff - Hawaii

STATE OF HAWAI`I
FAMILY COURT THIRD 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 COUNTY OF HAWAI`I

) ) )

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)

REPROGRAPHICS (6/08)

AFFIDAVIT OF PLAINTIFF (UDA) 3F-P-263

Reset Form

STATE OF HAWAI`I
FAMILY COURT THIRD 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 Hawai`i 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.
REPROGRAPHICS (6/08)

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AFFIDAVIT OF PLAINTIFF (UDA) 3F-P-263

STATE OF HAWAI`I
FAMILY COURT THIRD 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: ________________________________________________________________________

REPROGRAPHICS (6/08)

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AFFIDAVIT OF PLAINTIFF (UDA) 3F-P-263

STATE OF HAWAI`I
FAMILY COURT THIRD 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: 23a. u I attended ___________________________ on ___________________________________ . (Mo/Day/Yr) 23b. u I was excused by Judge _______________________________ from attending the Kids First 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
REPROGRAPHICS (6/08)

STATE OF HAWAI`I
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AFFIDAVIT OF PLAINTIFF (UDA) 3F-P-263