Transcription of AFFIDAVIT - Honolulu
1 AFFIDAVITSTATE OF hawaii )CITY AND COUNTY OF Honolulu )_____being first duly and says: [ I a m w e are] the [ fat her m other p arents g uardian(s)] of_____born on _____This AFFIDAVIT has been made in connection with the desire of the aforesaid child to secure a license to drive; I a m W e 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 : City and County of Honolulu , hawaii _____, 20 _____ _____ _____ _____Subscribed and sworn before me this _____dayof _____, 20 _____.
2 _____State of _____, _____Judicial CircuitMy commission expires: _____ (Stamp or Seal) (Stamp or Seal)CS-L-(DL) 239 (9/12)-mmSIGNATURE OF MOTHER /GUARDIAN/ LEGAL PARENT SIGNATURE OF FATHER /GUARDIAN / LEGAL PARENTPRINTED NAME PRINTED NAMEIDENTIFICATION PRESENTED EXP. DATE IDENTIFICATION PRESENTED EXP. DATE SIGNATURE OF EXAMINER DATE (FULL LEGAL NAME OF CHILD) (DATE OF BIRTH OF CHILD)Notary PublicNOTARY CERTIFICATION:( hawaii Administrative Rules 5-11-8)Document Date: _____ No. Pages: _____Document Description: _____ _____Notary Printed Name CircuitNotary Signature Dat
