002002 002002002002002002002002 [ ] Petitioner [ ] Respondent Pro Se IN THE FAMILY COURT OF THE SECOND CIRCUIT STATE OF HAWAII ) FC-P No. ) ) ACKNOWLEDGMENT OF Petitioner(s), ) PATERNITY ) vs. ) ) ) ) ) Respondent(s). ) ) ACKNOWLEDGMENT OF PATERNITY STATE OF HAWAII ) ) S S. COUNTY OF MAUI ) The undersigned Affiant, being duly sworn on oath, deposes and says: 1. That I am the [ ] Petitioner [ ] Respondent in the above-entitled case; 2. That I am the natural father of the child born to the above named 002[ ] Petitioner [ ] Respondent ; said child222s name, date of birth, place of birth and 002 sex are: 002 Name of Child: 002 Date of Birth: 002 Place of Birth: 002 Sex: 002 2FP-05 (Rev 11/11) CommonLook256 508 Certified American LegalNet, Inc. www.FormsWorkFlow.com 002002 002 3. I am aware that I have the right to have legal counsel represent me and I have been given the opportunity to secure counsel. I am aware that I have a right to trial and to request a genetic test. I am waiving these rights. 4. I hereby declare under penalty of perjury that I have read the Petition for Paternity, the Stipulated Judgment of Paternity, and this Affidavit; that I understand the same, that I freely sign the same without threat or coercion on the part of any person and that I have received a true copy of the same on this date. 5. [ ] I am not in the military service of the United States. [ ] I am in the military service of the United States and waive all rights which I may now have or will hereafter acquire under the Soldiers222 and Sailors222 Civil Relief Act of 1940, 50 U.S.C.A. Section 501 et. Seq. DATED: , Hawaii Respondent Pro Se STATE OF HAWAII ) ) SS. COUNTY OF MAUI ) 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 he executed the same as his free act and deed. Notary Public, Second Judicial Circuit S tate of Hawaii My 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-05 (Rev 11/11) CommonLook256 508 Certified American LegalNet, Inc. www.FormsWorkFlow.com