HomeMy WebLinkAboutAffidavit for Minor Fillable
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AFFIDAVIT
STATE OF HAWAII )
COUNTY OF HAWAII )
being first duly sworn.
Deposes and says: [ I am we are ] the [ father mother parents guardian(s)] of
born on
(FULL LEGAL NAME OF CHILD) (DATE OF BIRTH OF CHILD)
This affidavit has been made in connection with the desire of the aforesaid child to secure a license to drive;
I am We are willing to assume the obligation imposed by Section 286-112(b), HRS, “Any negligence or misconduct of a minor under the age of eighteen years when driving a motor vehicle upon a highway shall be
imputed to the person who has signed the application of the minor for a permit, provisional license, or license, which person shall be jointly and severally liable with the minor for any damages caused by the minor’s
negligence or misconduct.”
Further Affiant sayeth naught.
Dated: County of Hawaii
SIGNATURE OF MOTHER/GUARDIAN/LEGAL PARENT SIGNATURE OF FATHER/GUARDIAN/LEGAL PARENT
PRINTED NAME PRINTED NAME
IDENTIFICATION PRESENTED EXP. DATE IDENTIFICATION PRESENTED EXP. DATE
SIGNATURE OF EXAMINER DATE SIGNATURE OF EXAMINER DATE
FOR NOTARY USE ONLY:
Subscribed and sworn before my this __________ day
of __________________________ , 20___________ .
Notary Public
State of , Judicial Circuit __________________________
My commission expires: ___________________________
(Stamp or Seal)
NOTARY CERTIFICATION (Hawaii Administrative Rules 5-11-8)
Document Date:_____________No. Pages:________ Document Description:_________________________________
Notary Printed Name Circuit
Notary Signature Date
(Stamp or Seal)
FORM: VRL-L (DL)#900