Fill and Sign the For Themselves and for and on Behalf of Form

Form D – Rev. 02/2018 Page 16 ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) LAND COURT REGULAR SYSTEM________________ Name: Address: City, State, Zip Code: Telephone #: ________________________________________________________________________\ ______________ \ IN THE OFFICE OF THE LIEUTENANT GOVERNOR STATE OF HAWAII In the Matter o f the Petition ) ) of ) ) ) and (father) ) ) ) ORDER (mother) ) for themselves and for and on behalf of ) ) ) ) ) ) ) minor chi ldren ) ) For Change of Names ) Form D – Rev. 02/2018 Page 17 ORDER The Notice of Change of Names of \ , _______________________________________, _______________________________\ ___________, and _______________________________________having been published on in a newspaper of general circulation in the State of Hawaii , I, Douglas S. Chin, Lieutenant Governor of the State of Hawaii, by virtue of the authority vested in me by law and thereunto enabling, do hereby order that the names of _____________________________________, _________________________________\ ______, ___________________________________________, and ______________________________________ shall be changed to ____________________________, ________________________________________\ , __________________________, and _________________________ effective __________. Dated: Honolulu, Hawaii: _____________________ ___________________________________ DOUGLAS S. CHIN Lieutenant Governor of the State of Hawaii