Hawaii Affidavit of Plaintiff for Uncontested Divorce Form

CASE NUMBER
STATE OF HAWAII
AFFIDAVIT OF PLAINTIFF
(FOR UNCONTESTED DIVORCE)
FAMILY COURT
CIRCUIT
FC-D NO.
This document is prepared by
Plaintiff
Atty. for Plaintiff
_______________________________________
PLAINTIFF
(Your Full Name)
VS.
_______________________________________
Name
_______________________________________
_______________________________________
Address
_______________________________________
_______________________________________
DEFENDANT
(Your Spouse’s Full Name)
City, State, Zip
_______________________________________
Phone
STATE OF HAWAII
CITY AND COUNTY OF
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.
Plaintiff is representing him/herself.
2b.
Plaintiff is represented by the attorney named above.
3.
Service of process on Defendant was made by:
3a.
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
(Mo/Day/Yr) by a person
authorized to serve of legal documents.
3b.
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
(Mo/Day/Yr) have been filed. Plaintiff recognizes Defendant’s signature on
the return receipt.
3c.
Appearance and Waiver: Defendant acknowledged receipt of a filed copy of the Complaint and Summons
and signed an Appearance and Waiver on
(Mo/Day/Yr). Plaintiff recognizes Defendant’s
signature on the Appearance and Waiver.
3d.
Publication: The Affidavit of Publication was filed on
(Mo/Day/Yr).
4.
Default.
4a.
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.
An order granting the Motion for Entry of Default was filed on
(Mo/Day/Yr).
STATE OF HAWAII
FAMILY COURT
CIRCUIT
AFFIDAVIT OF PLAINTIFF
(FOR UNCONTESTED DIVORCE)
PAGE TWO
CASE NUMBER
FC-D NO.
5. Jurisdiction: (Check all that apply)
5a.
Plaintiff had been domiciled or physically present on the Island of
for a continuous period of at least
3 months prior to the filing of the Complaint for Divorce.
5b.
Plaintiff had been domiciled or physically in the State of Hawaii for a continuous period of at least
6 months prior to the filing of the Complaint for Divorce.
5c.
Defendant has been domiciled or physically present in the State of Hawaii for a continuous period of at
least 6 months prior to the filing of the Complaint for Divorce.
6. Defendant resides in (city, state) _______________________________________.
7. The parties were married on
(Mo/Day/Yr).
8. The parties last lived together in (city, state) _______________________________________, on
(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
(Mo/Day/Yr). To the
best of Plaintiff’s knowledge there have been no substantial changes in Plaintiff’s financial circumstances
since that date.
10b.
Defendant signed Income and Expense and Asset and Debt Statements on
Plaintiff recognizes Defendant’s signature on said documents.
10c.
Defendant’s Income and Expense Statement and Asset and Debt Statement are not filed because:
(Mo/Day/Yr)
______________________________________________________________________________
______________________________________________________________________________
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.
Plaintiff recognizes Defendant’s signature on the decree.
13. Wife wishes to resume the use of her
birth surname
former married name and be known as:
______________________________________________________________________________.
14. Husband wishes to resume the use of his
birth surname
former married name and be known as:
______________________________________________________________________________.
15. Language Comprehension:
15a.
Plaintiff fully understands the English language.
15b.
Although Plaintiff does not fully understand 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.
STATE OF HAWAII
FAMILY COURT
CIRCUIT
AFFIDAVIT OF PLAINTIFF
(FOR UNCONTESTED DIVORCE)
PAGE THREE
18. Pregnancy:
18a.
Wife is not pregnant.
18b.
Wife is pregnant and her expected date of delivery is
father of said child.
CASE NUMBER
FC-D NO.
(Mo/Day/Yr). Husband
is
is not the
19. Child(ren);
19a.
Plaintiff and Defendant have no children together.
19b.
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.
Name
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:
Date of Birth
Judgement of Paternity Entered
__________________________________________________________ (Mo/Day/Yr)
__________________________________________________________ (Mo/Day/Yr)
Yes
Yes
No
No
20. Prior or Pending Custody Proceedings:
20a.
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 Plaintiff and Defendant together.
20b.
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.
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: __________________________________________________________
STATE OF HAWAII
FAMILY COURT
CIRCUIT
21.
AFFIDAVIT OF PLAINTIFF
(FOR UNCONTESTED DIVORCE)
PAGE FOUR
CASE NUMBER
FC-D NO.
Plaintiff agrees to the custody arrangement and child support amounts as provided in the proposed divorce
decree.
22. Child Support:
22a.
Plaintiff believes that the information provided in the completed Child Support Guidelines Worksheet is
accurate, to the best of the Plaintiff’s knowledge and proposed child support is consistent with the Child
Support Guidelines Worksheet.
22b.
Proposed child support varies from the Child Support Guidelines Worksheet because of the following
exceptional circumstances: _______________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
23. Kids First:
23a.
I attended the Kids First II Program (Wednesday Night) on
(Mo/Day/Yr).
23b.
I was excused by Judge ___________________ from attending the Kids First II Program.
24.
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 eh best of his/her knowledge and belief.
PLAINTIFF’S SIGNATURE
SUBSCRIBED AND SWORN TO
BEFORE ME THIS DATE:
NOTARY PUBLIC’S SIGNATURE
IN ___________________, Hawaii
STATE OF HAWAII
MY COMMISSION EXPIRES:
[this page is intentionally left blank- please disregard and throw away]