Name Address City, State, Zip Code Telephone Number ~ Attorney for ~ Petitioner IN THE FAMILY COURT OF THE FIRST CIRCUIT STATE OF HAWAI221I In the Matter of the Guardianship of037 ) FC-G No. )) PROOF OF SERVICE ON , ) RESPONDENT (Full Legal Name) ) An Incapacitated Person. )036)036 PROOF OF SERVICE ON RESPONDENT I served a certified copy of the Petition for Appointment of a Guardian of an Incapacitated Person and Notice of Hearing in this action on the above-named Incapacitated Person (Respondent) at the following address: on at . (Date) (Time) DATED: Kapolei, Hawai221i, . Signature of Serving Officer or Adult Print complete name: Badge No. for Serving Officer: Address if other than Serving Officer: In accordance with the Americans with Disabilities Act, as amended, and other applicable state and federal laws, if you require a reasonable accommodation for a disability, please contact the ADA Coordinator at the First Circuit Family Court office by telephone at 954-8200, fax 954-8308, or via email at adarequest@courts.hawaii.gov at least ten (10) working days prior to your hearing or appointment date. FC Adm 2/27/14 PROOF OF SERVICE ON RESPONDENT