[ ]Plaintiff/Petitioner, Pro Se [ ] Defendant/Respondent, Pro Se [ ]Attorney for [ ] Plaintiff/Petitioner [ ] Defendant/Respondent IN THE FAMILY COURT OF THE SECOND CIRCUIT002 STATE OF HAWAI`I002 ) FC- NO. ) ) REQUEST FOR WITHDRAWAL Plaintiff/Petitioner, ) OF EXHIBITS AND RECEIPT ) vs. ) ) ) ) ) Defendant/Respondent. ) REQUEST FOR WITHDRAWAL OF EXHIBITS AND RECEIPT Undersigned requests withdrawal of the exhibits listed below in this cause for the reason that: [ ] The case has been tried and completed; appeal will not be taken, and the withdrawal of the exhibits will not prejudice the parties. [ ] Other reason withdrawal of exhibits will not prejudice the parties: 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 email adarequest@courts.hawaii.gov 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 American LegalNet, Inc. www.FormsWorkFlow.com Upon withdrawal, the listed exhibits will be delivered to the following person(s) who is (are) the person(s) entitled to them: Dated: , Maui, Hawai222i, . ATTORNEY REQUESTING PARTY APPROVED: DATE JUDGE RECEIVED from the court clerk the following exhibits entered in the above-entitled case: DATE RECIPIENT American LegalNet, Inc. www.FormsWorkFlow.com