STATE OF HAWAI‘I FAMILY COURT ___________ CIRCUIT MOTION AND AFFIDAVIT FOR PRE-DECREE RELIEF CASE NUMBER FC-D NO. Name, address, and telephone number of [ ] Movant [ ] Attorney for Movant: _________________________________________ PLAINTIFF vs. ________________________________________ DEFENDANT Attached hereto: [ ] Income and Expense Statement [ ] Asset and Debt Statement [ ] Child Support Guidelines Worksheet [ ] Custody/Visitation Statement [ ] Continuation Sheet [ ] _____________________________________ _____________________________________ [ ] Order for Pre-Decree Relief [ ] IMPORTANT This is a Domestic Abuse Case I am the [ ] Plaintiff [ ] Defendant in this case. I am referred to as the Movant in this motion. My spouse is referred to as the Respondent in this motion. Pursuant to Hawai‘i Family Court Rule 7 I seek the following relief: [ ] 1. An order which awards the temporary legal custody, physical custody and visitation of the parties’ child/ren as follows: ____________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ This arrangement is best for the parties’ child/ren because: _________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Note If custody and visitation orders are requested the attached Custody/Visitation Statement must be completed and the Movant’s Income and Expense and Asset and Debt Statements must be attached. [ ] 2. An order requiring the Respondent to pay monthly child support of $______________ . Note If child support is requested the Movant’s Income and Expense and Asset and Debt Statements must be attached. [ ] 3. An order requiring the Respondent to pay monthly alimony of $______________. Note If alimony is requested the Movant’s Income and Expense and Asset and Debt Statements must be attached. [ ] 4. An order requiring the Respondent to pay $___________ toward my legal expenses. Note If contribution to legal expenses is requested the Movant’s Income and Expense and Asset and Debt Statements must be attached. Page 1 of 3 Revised 10/04/04 Motion and Affidavit for Pre-Decree Relief American LegalNet, Inc. www.FormsWorkflow.com [ ] 5. An order requiring the Respondent to make the following other payments: _________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Note If such an order is requested the Movant’s Income and Expense and Asset and Debt Statements must be attached. [ ] 6. An order requiring mediation on the issues raised by this motion. [ ] 7. An order directing a social study by the Family Court regarding the custody and/or visitation issues raised by this motion. [ ] 8. An order which enjoins and restrains the Respondent from transferring, encumbering, wasting, or otherwise disposing of any of his or her real or personal property, except as necessary, over and above current income, for the ordinary course of business or for usual living expenses. Such a restraining order is necessary because: ______________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ [ ] 9. An order which enjoins and restrains the Respondent from removing the parties’ child/ren from the City and County of Honolulu. Such a restraining order is necessary because: ____________________________________________________________________________________ _____________________________________________________________________________________________ [ ] 10. An order which enjoins and restrains the Respondent from physically abusing, threatening, or harassing me and/or the parties’ child/ren because: a. The Respondent has physically abused me in the past as follows (state nature and date of most recent incident of abuse): __________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ b. The Respondent has threatened to abuse me in the past as follows (state nature and date of most recent threat of abuse): ____________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ [ ] 11. The Respondent owns, intends to obtain or transfer ownership of, or possesses a firearm or ammunition and the firearm may be used to threaten, injure or abuse any person, as follows: a. The Respondent [ ] owns [ ] possesses the following type(s) of firearm(s): ____________ ________________________________________________________________________________________ As of __________________(date), the firearm(s) was/were located at (state address and specific location therein): _______________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ b. I believe that the Respondent intends to obtain or transfer ownership of (a) firearm(s) because: _______________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ c. In the past the Respondent has [ ] used [ ] threatened to use (a) firearm(s) against me and/or the parties’ child/ren as follows (state nature and date of the last such use and/or threatened use): ________________________________________________________________ ________________________________________________________________________________________ Page 2 of 3 Revised 10/04/04 Motion and Affidavit for Pre-Decree Relief American LegalNet, Inc. www.FormsWorkflow.com d. I believe that the Respondent may in the future use (a) firearm(s) to threaten, injure and/or abuse me, the parties’ child/ren and/or someone else because: __________________ ________________________________________________________________________________________ ________________________________________________________________________________________ [ ] 12. The Respondent’s name, address, date of birth, telephone number, and social security number are: Name _________________________________________________________________________________ Address _______________________________________________________________________________ Date of Birth ____________________________ Telephone Number __________________________ Social Security Number _______________________________________________________________ [ ] 13. Other relief sought: _____________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ In further support of this motion I also affirm: [ ] 14. I am not now, nor have I been in the past, a party to a legal proceeding other than this case involving the Respondent. [ ] 15. My participation as a party in other legal proceedings involving the Respondent is/has been as follows: Case name _____________________________________________________________________________ Case number __________________________________________________________________________ Location of Court ______________________________________________________________________ Date filed _________________________ Date concluded ____________________________________ Type of case ___________________________________________________________________________ Case name _____________________________________________________________________________ Case number __________________________________________________________________________ Location of Court ______________________________________________________________________ Date filed _________________________ Date concluded ____________________________________ Type of case ___________________________________________________________________________ I hereby declare under penalty of perjury that the information in this motion and all of the attachments to it is true, correct, and complete to the best of my knowledge and belief. Subscribed and sworn to before me ______________________________________________ Movant’s Signature this _____ day of _____________, 20__. Name: Signature: NOTARY PUBLIC, State of Hawai‘i My commission expires: Page 3 of 3 Revised 10/04/04 Motion and Affidavit for Pre-Decree Relief American LegalNet, Inc. www.FormsWorkflow.com