STATE OF HAWAI221IAFFIDAVIT OF PLAINTIFFCASE NUMBERFAMILY COURT(FOR UNCONTESTED DIVORCE)FC-D No. FIRST CIRCUITThis document is prepared by:[]Plaintiff[]Attorney for PlaintiffName(Full Name)Plaintiff,v.AddressCity, State, Zip Code(Full Name)Defendant.Telephone NumberSTATE OF HAWAI221I ))CITY AND COUNTY OF HONOLULU)Plaintiff in the above-entitled action, being first duly sworn on oath, deposes and says that:1.Plaintiff222s 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 beenfiled showing that the Defendant was personally served with a filedcopy of the Complaint for Divorce; Automatic Restraining Order;Summons to Answer Complaint on(Month/Day/Year)by a person authorized to serve legal documents.COURT USE ONLYFC Adm 7/5/18PAGE 1 OF 6 PAGESAFFIDAVIT OF PLAINTIFF (UDA) 1F-P-333In accordance with the Americans with Disabilities Act, as amended, and other applicable state and federal laws, if yourequire accommodation for a disability, please contact the ADA Coordinator at the First Circuit Family Court office bytelephone at 954-8200, fax 954-8308, or via email at adarequest@courts.hawaii.gov at least ten (10) days prior to yourhearing or appointment date.Please call the Family Court Service Center at 954-8290 if you have any questions about forms or procedures. American LegalNet, Inc. www.FormsWorkFlow.com STATE OF HAWAI221IAFFIDAVIT OF PLAINTIFFCASE NUMBERFAMILY COURT(FOR UNCONTESTED DIVORCE)FC-D No. FIRST CIRCUIT3b.[]Certified or Registered Mail : A filed copy of the Complaint for Divorce; Automatic RestrainingOrder; and Summons to Answer Complaint were served upon Defendant by certified or registeredmail. A Statement of Mailing or Affidavit of Mailing and an original return receipt signed by theDefendant on have been filed. Plaintiff recognizes Defendant222s(Month/Day/Year)signature on the return receipt.3c.[]Appearance and Waiver: Defendant acknowledged receipt of a filed copy of the Complaint forDivorce; Automatic Restraining Order; and Summons to Answer Complaint for Divorce and signedan Appearance and Waiver on . Plaintiff recognizes Defendant222s (Month/Day/Year)signature on the Appearance and Waiver.3d.[]Publication: The Affidavit of Publication was filed on .(Month/Day/Year)4.[]Default.4a.[]More than twenty (20) days have passed since the service of the Complaint for Divorce; AutomaticRestraining Order; and Summons to Answer Complaint upon Defendant. No responsive pleadinghas been filed. Neither Plaintiff nor Plaintiff222s attorney has received any communication fromDefendant or Defendant222s attorney concerning this case since the Complaint for Divorce; AutomaticRestraining Order; and Summons to Answer Complaint was served.4b.[]An order granting the Motion for Entry of Default was filed on .(Month/Day/Year)5.Jurisdiction:5a.[]Plaintiff had been domiciled or physically present on the Island of O221ahu for a continuous periodat least 3 months prior to the filing of the Complaint for Divorce; Automatic Restraining Order;and Summons to Answer Complaint for Divorce.5b.[]Plaintiff had been domiciled or physically present on the State of Hawai221i for a continuous period ofleast 6 months prior to the filing of the Complaint for Divorce; Automatic Restraining Order; andSummons to Answer Complaint for Divorce.5c.[]Defendant had been domiciled or physically present on the State of Hawai221i for a continuous periodleast 6 months prior to the filing of the Complaint for Divorce; Automatic Restraining Order; andSummons to Answer Complaint for Divorce.5d.[]Plaintiff222s resident State does not recognize same sex marriage.6.Defendant resides in ,.(City)(State)7.The parties were married onin,.(Month/Day/Year)(City)(State) FC Adm 7/5/18PAGE 2 OF 6 PAGESAFFIDAVIT OF PLAINTIFF (UDA) 1F-P-333 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF HAWAI221IAFFIDAVIT OF PLAINTIFFCASE NUMBERFAMILY COURT(FOR UNCONTESTED DIVORCE)FC-D No. FIRST CIRCUIT8.The parties last lived together in,on.(City)(State)(Month/Day/Year)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.(Month/Day/Year)To the best of Plaintiff222s knowledge there have been no substantial changes in Plaintiff222s financialcircumstances since that date.10b.[]On, Defendant signed an Income and Expense Statement and an(Month/Day/Year)Asset and Debt Statement. Plaintiff recognizes Defendant222s signature on said documents.10c.[]Defendant222s Income and Expense Statement and Asset and Debt Statement are not filed because:11.Plaintiff has carefully reviewed the proposed Divorce Decree (223Decree224) and agrees to the alimony, divisionof property and other provisions as provided in the proposed Decree.12.Plaintiff signed the proposed Decree.[]Plaintiff recognizes Defendant222s signature on the Decree.13.Plaintiff wishes to resume the use of his/her[]birth surname[]former married name and be known as:.14.Defendant wishes to resume the use of his/her[]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 comprehend written English, this document has been explained tohim/her by and based on that explanationPlaintiff understands this document.16.Plaintiff requests that the court grant this divorce and enter the Decree without his/her appearance in court.FC Adm 7/5/18PAGE 3 OF 6 PAGESAFFIDAVIT OF PLAINTIFF (UDA) 1F-P-333 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF HAWAI221IAFFIDAVIT OF PLAINTIFFCASE NUMBERFAMILY COURT(FOR UNCONTESTED DIVORCE)FC-D No. FIRST CIRCUIT17.Plaintiff has read this document and signs it voluntarily and without coercion and duress and not becausehe/she was told to sign it.18.Pregnancy:18a.[]Plaintiff is not pregnant.18b.[]Plaintiff is pregnant and her expected date of delivery is.(Month/Day/Year)Defendant[]is[]is not the father of said child.18c.[]Defendant is not pregnant.18d.[]Defendant is pregnant and her expected date of delivery is.(Month/Day/Year)Plaintiff[]is[]is not the father of said child.19.Child(ren):19a.[]Plaintiff and Defendant have no children together.19b.[]The parties have child(ren) together. The full names and birthdates are listed below from theoldest to the youngest child (including adult child(ren)). NameDate of Birth (Month/Day/Year)19c.[]There is/are child(ren) conceived during this marriage who were fathered by someone other than myspouse. The child(ren)222s name(s) and birthdate(s) are listed below: NameDate of Birth (Month/Day/Year)Judgment of Paternity entered? YesNo[][][][][][][][][][][][]FC Adm 7/5/18PAGE 4 OF 6 PAGESAFFIDAVIT OF PLAINTIFF (UDA) 1F-P-333 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF HAWAI221IAFFIDAVIT OF PLAINTIFFCASE NUMBERFAMILY COURT(FOR UNCONTESTED DIVORCE)FC-D No.FIRST CIRCUIT20.Prior or Pending Custody Proceedings:20a.[]I have not participated in any capacity in any law suit or proceeding in any state concerningcustody of the minor child(ren) of the Plaintiff and Defendant together. I have no information ofany pending custody proceeding or of any person not a party to this proceeding who has physicalcustody or claims to have custody or visitation rights concerning any minor child(ren) of thePlaintiff and Defendant together.20b.[]Prior court case involving the subject child(ren):Case Name:Case Number:Location (City, State) of Court:Date (Month/Day/Year) Filed:Date (Month/Day/Year) Concluded:Type of Case:20c.[]Other pending court case involving the subject child(ren): Case Name:Case Number:Location (City, State) of Court:Date (Month/Day/Year) Filed:Date (Month/Day/Year) Concluded:Type of Case:21.Plaintiff agrees to the custody arrangement and child support amounts as provided in the proposed civilDivorce Decree. 22.Child Support:22a.[]Plaintiff believes that the information provided in the completed Child Support GuidelinesWorksheet is accurate to the best of the Plain