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 of ) ) FC-G No. ) STATEMENT OF MAILING RE: (Full Legal Name) , ) ) (Name of Party) ; An Incapacitated Person. ) ) EXHIBITS 1 AND 2 STATEMENT OF MAILING RE: (Name of Party) I represent that I mailed a certified copy of the Petition for the Appointment of a Guardian of Incapacitated Person and Notice of Hearing by certified or registered mail, return receipt requested ~restricted delivery to addressee as follows: NAME:037 ADDRESS:037 CITY, STATE, ZIP CODE:037 At the time of mailing, the Post Office receipt attached hereto as Exhibit 2231224 was postmarked and dated. Thereafter, the return receipt attached as Exhibit 2232224 was received. DATED: Kapolei, Hawai221i, . Signature Print complete name: In accordance with the Americans with Disabilities Act, as amended, and other applicable state and federal laws, if yourequire a reasonable accommodation for a disability, please contact the ADA Coordinator at the First Circuit Family Courtoffice by telephone at 954-8200, fax 954-8308, or via email at adarequest@courts.hawaii.gov at least ten (10) working daysprior to your hearing or appointment date. Please call the Family Court Service Center at 954-8290 if you have any questions regarding forms or procedures. FC Adm 2/27/14 PAGE 1 OF 2 PAGES STATEMENT OF MAILING; EXHIBITS 1 AND 2 Instructions: Submit a separate Statement f Mailing for each party served by mail. (ATTACH POST OFFICE RECEIPT) (ATTACH RETURN RECEIPT) EXHIBIT 1 EXHIBIT 2037037FC Adm 2/27/14 PAGE 2 OF 2 PAGES STATEMENT OF MAILING; EXHIBITS 1 AND 2037037