Statements Of Mailing Exhibits 1 And 2 {1F-P-740}

STATE OF HAWAI`I FAMILY COURT FIRST CIRCUIT STATEMENT OF MAILING EXHIBITS "1" AND "2" (Re: Income Withholding Order/Notice of Support) CASE NUMBER FC-D No. This document is prepared by ~ Attorney for ~ Plaintiff ~ Defendant Name (Full Name) v. PLAINTIFF Address City, State, Zip Code (Full Name) DEFENDANT Telephone No. STATEMENT OF MAILING I REPRESENT THAT I caused one certified copy of the Income Withholding Order/Notice of Support to be mailed by certified or registered mail, return receipt requested. to: Child Support Payor's Employer's Name Employer's Address City, State, Zip Code 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 ~ PLAINTIFF'S ~ DEFENDANT'S SIGNATURE In accordance with the Americans with Disabilities Act, as amended, and other applicable state and federal laws, if you require accommodation for a disability, please contact the ADA Coordinator at the First Circuit Family Court office by telephone at 954-8200, fax 954-8308, or via email at adarequest@courts.hawaii.gov at least ten (10) days prior to your hearing or appointment date. Please call the Family Court Service Center at (808)954-8290 if you have any questions regarding forms or procedures. FCAdm 1/13/14 COURT USE ONLY STATEMENT OF MAILING (Re: Income Withholding Order/Notice of Support), EXHIBITS "1" AND "2" American LegalNet, Inc. www.FormsWorkFlow.com EXHIBIT "1" EXHIBIT "2" American LegalNet, Inc. www.FormsWorkFlow.com