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PETITION FOR STANDING IN A CONTESTED CASE HEARING <br /> (Pa-, 2 of 2) <br /> C_cD. are you a person or persons descended from native Hawaiians who inhabited the <br /> Hawaiian Islands prior to 1778, who practiced those ri`, �►hich were customarily and <br /> traditionally exercised for subsistence, cultural, or religious purposes? <br /> Yes No ✓ <br /> If the answer is "yes", please submit any genealogical evidence and historical evidence <br /> showing the exercise of those rights to support your statement: <br /> Petitioner's Signature <br /> STATE OF HAWA I ) <br /> SS. <br /> COUNTY OF IIA 'Ail ) <br /> On this i�d y of _ _ 202ibefore nee personally appeared <br /> (J� to me known to be the person described in and who executed <br /> the fo „oina instru •h�c (owled`,ed that I aecuted the sai is free nd deed. <br /> NOTARY <br /> PUBLIC <br /> Comm.No. - N tars ub i , State o <br /> '. 19-1 <br /> E OF N \1MV commission ezplres: <br /> ` ,�NA A ANcy�T, OTt <br /> NOTARY Na, h1. CI <br /> PUBLIC <br /> up- •­0 - Day:ripSlon: <br /> Comm,.No. Appcndix A <br /> OF <br /> ' l111111\\ <br />