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<br />AFFIDAVIT <br /> <br />State of Hawai’i } <br /> } <br />County of Hawai’i } <br /> <br /> <br /> being first duly sworn, <br /> <br />deposes and says: I am the \[ father/mother spouse guardian other\] of <br /> <br /> Date of Birth: <br />(FULL LEGAL NAME OF APPLICANT) <br /> <br /> That this Affidavit has been made in connection with the desire of Applicant to secure <br />a state civil identification card or driver’s license; <br /> <br /> That the Applicant resides with Affiant and document(s) for proof of principal <br />residence address is under Affiant’s name; <br /> <br /> That Affiant is submitting document(s) in support of proof of principal residence <br />address as indicated under the List of Acceptable Documents for Proof of Principal Residence <br />Address displaying name and address of Affiant; <br /> <br /> Further Affiant sayeth naught. <br /> <br />Dated: <br /> <br /> <br />Signature of Father/Mother/Spouse/Guardian/Other <br /> <br /> <br />PRINTED NAME <br /> <br /> <br />IDENTIFICATION PRESENTED EXP DATE <br /> <br /> <br />SIGNATURE OF EXAMINER DATE <br /> <br />FOR NOTARY USE ONLY: <br /> <br />Subscribed and sworn before me this _______ day <br />NOTARY CERTIFICATION <br /> <br />(Hawaii Administrative Rules 5-11-8) <br />Of ____________________, 20______. <br /> <br /> <br />Document Date: _______________ No. Pages: ________ <br />_________________________________________ <br /> <br /> Notary Public <br />Document Description: ____________________________ <br /> <br /> <br />State of ______________, ________Judicial Circuit <br />_______________________________________________ <br /> <br /> <br />_____________________________ _________________ <br />My commission expires: _____________________ <br />Notary Printed Name Circuit <br /> <br />_____________________________ _________________ <br /> <br />Notary Signature Date <br /> (Stamp or Seal) <br />FORM: VRL-L (SID/DL) 401 <br />REV. 10/01/2014 <br /> <br />