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Hawaii Affidavit for Parental Consent Form


Hawaii Affidavit for Parental Consent Form
Hawaii Affidavit for Parental Consent Form
AFFIDAVIT
(Minor 10 through 13 years of age)
)
STATE OF HAWAII )
)
being first duly sworn,
deposes and says: I am the [ father mother guardian] of
born on
(FULL LEGAL NAME OF CHILD) (DATE OF BIRTH OF CHILD)
That this affidavit has been made in connection with the desire of Affiant to secure a state civil identification
card on behalf of the minor child;
That the minor child is at least 10 years of age and under the age of fourteen (14) and requires Affiant’s
signature;
That the minor child principal residence is with the Affiant and Affiant is submitting two (2) documents in
support of proof of principal residence address as indicated under the List of Acceptable Documents for Proof of
Principal Residence Address displaying name and address of Affiant and;
Further Affiant sayeth naught.
Dated:
________________________________________
SIGNATURE OF FATHER/MOTHER/GUARDIAN
PRINTED NAME
IDENTIFICATION PRESENTED EXP. DATE
________________________________________
SIGNATURE OF EXAMINER DATE
NOTARIZATION REQUIRED IF SIGNATURE NOT VERIFIED BY DRIVER LICENSE STAFF
FOR NOTARY USE ONLY:
Subscribed and sworn before me this __________ day NOTARY CERTIFICATION
(Hawaii Administrative Rules 5-11-8)
of __________________________ , 20___________ .
Document Date:_____________No. Pages:________
____________________________________________
Notary Public
Document
Description:_________________________________
State of ___________________, _______Judicial Circuit ________________________ _________________
Notary Printed Name Circuit
My commission expires: ___________________________ ________________________ _________________
Notary Signature Date
(Stamp or Seal)
(Stamp or Seal)
Hawaii Affidavit for Parental Consent Form