] Petitioner [ ] Respondent Pro Se [ IN THE FAMILY COURT OF THE SECOND CIRCUIT STATE OF HAWAII Petitioner(s), 003vs. Respondent(s). FC-P No. ACKNOWLEDGMENT OF MATERNITY AND PATERNITY ) 002) 002ACKNOWLEDGMENT OF MATERNITY AND PATERNITY STATE OF HAWAII COUNTY OF MAUI SS. ) The undersigned Affiant, being duly sworn on oath, deposes and says: 1. That she is a Petitioner Respondent in the above entitled case: 2. That she is the mother of the subject child whose name, date of birth, place of birth and sex are as follows: Name of Child:Sex:Date of Birth:Place of Birth:) ) ) ) ) )002 )002 )002 )002 )002 ) ) [ ] [ ] 2FP-04 (Rev 11/11) CommonLook256 508 Certified003 American LegalNet, Inc. www.FormsWorkFlow.com 3. That Petitioner Respondent is the natural father of said child. DATE: , Hawaii Respondent Pro Se ) ) STATE OF HAWAII COUNTY OF MAUI SS. ) On this day of , 20 before me personally appeared , to me known to be the person described in and who executed the foregoing instrument and acknowledged that she executed the same as her free act and deed. Notary Public, Second Judicial CircuitState of HawaiiMy Commission Expires: In accordance with the Americans with Disabilities Act and other applicable state and federal laws, if you require a reasonable accommodation for a disability, please contact the ADA Coordinator at the Family Court Administration Office at PHONE NO. 244-2700, FAX 244-2704 OR TTY 244-2889 at least ten (10) working days prior to your hearing or appointment date. For all Civil related matters, please call 244-2706 or visit the Service Center at 2145 Main Street, Room 141, Wailuku, HI 96793 2FP-04 (Rev 11/11) [ ] [ ] CommonLook256 508 Certified American LegalNet, Inc. www.FormsWorkFlow.com