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PETITION FOR STANDING IN CONTESTED CASE HEARING <br />(Page 2 of 2) <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 ___ <br />If the answer is "yes", please submit any geneological evidence and historical evidence <br />showing the exercise of those rights to support the statement. <br />________________________________________________________________________ <br />________________________________________________________________________ <br />________________________________________________________________________ <br />________________________________________________________________________ <br />________________________________________________________________________ <br />________________________________________________________________________ <br />________________________________________________________________________ <br />________________________________________________________________________ <br />________________________________________________________________________ <br />________________________________________ <br />Petitioner’s Signature <br />STATE OF HAWAII ) <br /> ) SS. <br />COUNTY OF HAWAII ) <br />On this day of, 20___, before me personally appeared __________________, <br />to me known to be the person described in and who executed the foregoing instrument, and <br />acknowledged that he executed the same as his free act and deed. <br /> _______________________________________ <br /> Notary Public, State of Hawaii <br />My commission expires: ___________________ <br />APPENDIX A <br /> <br />