Laserfiche WebLink
I_1aaIU_ TJII <br />STATE OF HAWAII ) <br />CITY AND COUNTY OF HONOLULU ) <br />being first duly sworn. <br />Deposes and says: [ ❑ I am ❑ we are] the [ ❑ father ❑ mother ❑ parents ❑ guardian(s)] of <br />born on <br />(FULL LEGAL NAME OF CHILD) (DATE OF BIRTH OF CHILD) <br />This affidavit has been made in connection with the desire of the aforesaid child to secure a license to drive; <br />❑ I am ❑ We are willing to assume the obligation imposed by Section 286- 112(b), HRS, "Any negligence or <br />misconduct of a minor under the age of eighteen years when driving a motor vehicle upon a highway shall be imputed to <br />the person who has signed the application of the minor for a permit, provisional license, or license, which person shall be <br />jointly and severally liable with the minor for any damages caused by the minor's negligence or misconduct." <br />Further Affiant sayeth naught. <br />Dated: City and County of Honolulu, Hawaii 120 <br />SIGNATURE OF MOTHER/ GUARDIAN / LEGAL PARENT <br />PRINTED NAME <br />IDENTIFICATION PRESENTED <br />EXP. DATE <br />Subscribed and sworn before me this day <br />of 120 <br />Notary Public <br />State of <br />My commission expires: <br />(Stamp or Seal) <br />CS- L -(DL) 239 (9/12) -mm <br />Judicial Circuit <br />SIGNATURE OF FATHER /GUARDIAN /LEGAL PARENT <br />PRINTED NAME <br />IDENTIFICATION PRESENTED EXP. DATE <br />SIGNATURE OF EXAMINER DATE <br />NOTARY CERTIFICATION: <br />(Hawaii Administrative Rules §5 -11 -8) <br />Document Date: <br />Document Description: <br />Notary Printed Name <br />Notary Signature <br />(Stamp or Seal) <br />No. Pages: <br />Circuit <br />Date <br />