STATE OF HAWAI‘I FAMILY COURT _________ CIRCUIT CASE NUMBER STATEMENT OF MAILING EXHIBITS “1” AND “2” FC-D NO. This document is prepared by u PLAINTIFF (Full Name) Plaintiff u Atty. for Plaintiff _________________________________________________ Name _________________________________________________ VS. _________________________________________________ Address _________________________________________________ DEFENDANT (Full Name) City, State, Zip _________________________________________________ Phone STATEMENT OF MAILING I REPRESENT THAT I caused one certified copy each of the Complaint For Divorce; Summons to Answer Complaint; and Motion for Service by Mail and Affidavit; Order for Service by Mail; and _________________________________, to be mailed by certified or registered mail, return receipt requested, restricted delivery to: _________________________________________________________________________________ Defendant’s Name _________________________________________________________________________________ Defendant’s Address _________________________________________________________________________________ City/State/Zip Defendant At the time of mailing, the receipt attached hereto as Exhibit “1” was postmarked and dated. Thereafter, the return receipt attached as Exhibit “2” was received. DATE 4/98 PLAINTIFF’S SIGNATURE STATEMENT OF MAILING/EXHIBITS “1” AND “2” American LegalNet, Inc. 1F-P-3XX www.FormsWorkflow.com EXHIBIT “1” EXHIBIT “2” American LegalNet, Inc. www.FormsWorkflow.com