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PETITION FOR STANDING IN A CONTESTED CASE HEARING <br /> (Page 2 of?) <br /> D. Are you a person or persons descended from native Hawaiians who inhabited the <br /> Hawaiian Islands prior to 1778, who practiced those rights which were customarily and <br /> traditionally exercised for subsistence, cultural, or religious purposes`' <br /> Yes No x <br /> If the answer is"ves", please submit any genealogical evidence and historical evidence <br /> showing the exercise of those rights to support your statement: <br /> Petitioner's Signature <br /> l� <br /> STATE OF <br /> 4k ) <br /> 45 S, ) SS. <br /> COUNTY OF HAW"All ) <br /> f� On this 1 —day of �� 202,P5, before me personally appeared <br /> Lj-kj , Lj-l0Ik 2+o me known to be the person described in and who executed <br /> the foregoing instrument. a knowledged that he executed the same as his free act and deed. <br /> A notary public or other officer completing this <br /> certificate verifies only the identity of the <br /> individual who signed the document to which this <br /> .1EANlNE MOROwi;Z certificate is attached,and not the truthfulness, <br /> Merry Public-CAW.,nia accuracy,or validity of that document <br /> i LOSAngales CoUnty g Public. State of Hawaii <br /> Commission N 2373226 <br /> MV Comm.Expires Sap S,202a �/ 1 <br /> My commission expires: V <br /> Appendix A <br />