Fill and Sign the Instructions for Change of Name Hawaiigov Form

Form F – Rev. 02/2018 Page 6 IN THE OFFICE OF THE LIEUTENANT GOVERNOR OF THE STATE OF HAWAII In the Matter of the Petition ) ) of ) ) (1) ___________________________ ) ) for and on behalf of ) ) __________________________ ) ) __________________________ ) ) __________________________ ) minor children ) ) For Change of Name ) PETITION TO THE HONORABLE DOUGLAS S. CHIN, LIEUTENANT , GOVERNOR OF THE STATE OF HAWAII: (2) COMES NOW _____________________________your petitioner herein, (3) and respectfully prays that an order be entered herein changing ____name and the names of minor(s) named above, and in support thereof represents as follows: I. (4) That the Petitioner is _______________________________________________________; date of birth is __________________________________________________________________; (petitioner) place of birth is _________________________________________________________________; (petitioner) petitioner’s father’s name is (Names as shown on birth certificate) ________________________________________________________________________\ _______; petitioner’s mother’s mai den name is _________________________________________________; (First) (Middle) (Surname) Form F – Rev. 02/2018 Page 7 II. (5) That the name on your Pet itioner’s birth certificate and/or certificate of naturalization is ____________________________________________________. III. (6) That other names Petitioner is using or has used are as follows: _________________________________________________________________. IV. (7) That the father or mother of the minor(s) is_________________________ who resides at _____________________________; and who has attached a signed and notarized consent to change of name of the minor. V. (8) That your petitioner is a resident of the State of Hawaii , and present address is _______________________________________________. VI. (9) That you Petitioner is the parent of the following minor children: Names on Birth Certificate Date of Birth Place of Birth VII. (10) That you Petitioner: has not been convicted of a felony or a sexual offense. has been convicted of a felony. has been convicted of a sexual offense Form F – Rev. 02/2018 Page 8 Felony or Sexual Offense Date of Conviction Disposition If Petitioner 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, by whom the pardon was granted. VII. That this Petition is not filed for the purpose of avoiding payment of debts to creditors; your Petitioner has been and is a good law abiding citizen and your Petitioner states that this Petition for Change of Name is not for wrong or fraudulent purposes. XI. (11) That your Petitioner is now requesting a Change of Name to __________________________________ and that the names(s) of Petitioner’s minor(s) also be changed to ___________________________and _________________________________. Form F – Rev. 02/2018 Page 9 (12) WHEREFORE, your Petitioner prays that an order be entered herein changing Petitioner’s name and those of the minor(s) listed herein from __________________________________ to ________________________________; and f rom __________________________________ to ________________________________; and f rom __________________________________ to ________________________________; and f rom __________________________________ to ________________________________. (13) DATED:________________________________, Hawaii. (14) ___________________________________________ Petitioner (sign name in full) STATE OF HAWAII ) ) COUNTY OF _______________ ) SS. (Honolulu, Hawaii, Maui, Kauai) (15) ________________________________, being first duly sworn on oath depose and says: That Petitioner is the person named herein, that Petitioner has read the foregoing Petition, knows the contents thereof, and that the same is true to the best of Petitioner’s knowledge. (1 6) ___________________________________________ Petitioner (Sign name in full) Subscribed and sworn to before me this ______ day of ________________, 20____ (Notary Stamp or Seal) Notary Public, State of Hawaii Printed Name: __________________________ My Commission Expires: _________________ Doc. Date: ____________ # Pages: __________ Notary Name: __________________ ___ Circuit Doc. Description: _________________________ ________________________________________ ( Stamp or seal) ________________________________________ Notary Signature Date