Fill and Sign the Form D Hawaiigov

Form D – Rev. 02/2018 Page 7 IN THE OFFICE OF THE LIEUTENANT GOVERNOR OF THE STATE OF HAWAII In the Matter of the Petition ) ) of ) ) (1) ) and (father) ) ) ) (mother) ) for themselves and for and on behalf of ) ) ) ) ) ) _________________________________ ) minor children, ) ) For Change of Names ) ) PETITION TO THE HONORABLE DOUGLAS S. CHIN, LIEUTENANT GOVERNOR OF THE STATE OF HAWAII: (2) COMES NOW ____________________________________________________ (father) and \ your Petitioners herein, and respe ctfully (mother) pray that an order be entered herein changing their names and the names of their minor child and in support thereof represent as follows: I. (father) (3) That your Petitioner is \ , whose date of birth is \ _; place of birth is \ ; father’s name is \ ; (First, middle, and surname) mother’s name is \ ; (First, middle, and surname) Form D – Rev. 02/2018 Page 8 (4) That the name on your Petitioner’s birth certificate/certificate of naturalization is \ . (5) That other names Petitioner is using or has used are as follows: \ \ . II. (mother) (6) That your Petitioner is \ , date of birth is \ ; place of birth is \ ; father’s name is \ ; (First, middle, and surname) mother’s name is \ ; (First, middle, and surname) (7) That the name on your Petitioner’s birth certificate/certificate of naturalization is \ . (8) That other names Petitioner is using or has used are as follows: \ \ . III. (9) That your Petitioner’s residence is in the State of ___________________ and their present address is \ . (residential address) IV. That your Petitioners are the parents of the following minor children: Name on Birth Certificate Date of Birth Place of Birth (10) _____________________ ___________ ___________ ______________________ ___________ ___________ ______________________ ___________ ___________ Form D – Rev. 02/2018 Page 9 V. (11) That your Petitioner Husband: has not been convicted of a felony or a sexual offense. has been convicted of a felony. ____ has been convicted of a sexual offense. Felony or Sexual Offense Date of Conviction Disposition If Petitioner Husband has been convicted of a felony or a sexual offense, respond to the following questions: 1. Fully explain the charges. 2. Fully explain the sentence. 3. Fully explain the terms and conditions of parole or probation. 4. Fully explain the date of final discharge of the sentence. 5. Fully explain whether there was a deferred acceptance of a guilty or no contest plea. 6. Fully explain if there was a pardon, and by whom the pardon was granted. That your Petitioner Wife: has not been convicted of a felony or a sexual offense. has been convicted of a felony. _____ has been convicted of a sexual offense. Felony or Sexual Offense Date of Conviction Disposition Form D – Rev. 02/2018 Page 10 If Petitioner Wife has been convicted of a felony, respond to the following questions: 1. Fully explain the charges. 2. Fully explain the sentence. 3. Fully explain the terms and conditions of parole or probation. 4. Fully explain the date of final discharge of the sentence. 5. Fully explain whether there was a deferred acceptance of a guilty or no contest plea. 6. Fully explain if there was a pardon, and by whom the pardon was granted. VI. That this Petition is not filed for the purpose of avoiding payment of debts to creditors; your Petitioners have been and are good law- abiding citizens and your Petitioners state that this Petition for Change of Name is not for wrong or fraudulent purposes. VII. (12) That your Petitioners are now requesting that they be permitted to change their names to \ and \ , (father) (mother) and of their minor children to \ , _________________________________and \ . WHEREFORE, your Petitioners pray that an order be entered herein cha nging the names as follows: (13) FROM TO _______________________ ______________________ _______________________ ______________________ _______________________ ______________________ Form D – Rev. 02/2018 Page 11 _______________________ ______________________ _______________________ ______________________ (14) DATED: , Hawaii. (15) ________________________________ Petitioner (Father sign name in full) ________________________________ Petitioner (Mother sign name in full) State of Hawaii ) ) County of ) SS. (Honolulu, Hawaii, Maui, Kauai) ) (16) \ and (father) \ being first duly sworn on oath depose (mother) and say: That they are the Petitioners named herein, that they have read the foregoing Petition, know the contents thereof, and that the same are true to the best of their knowledge. (17) ________________________________ Petitioner (Father sign name in full) ________________________________ Petitioner (Mother sign name in full) Subscribed and sworn to before me this ______ day of ________________, 20____. (Notary Stamp or Seal) Not ary Public, State of Hawaii Printed Name: __________________________ My Commission Expires: _________________ Doc. Date: ____________ # Pages: __________ Notary Name: __________________ ___ Circuit Doc. Description: _________________________ ________________________________________ ( Stamp or seal) ________________________________________ Notary Signature Date