STATE OF HAWAI‘I
With Minor and/or Dependent Child(ren)
FAMILY COURT FC-D No.
Failure of Party to Perform: If either party fails to execute any document in compliance with
this Decree, the other party may submit a motion to the Court, requesting that the Court appoint
the Chief Clerk of the Court to execute said document on behalf of the non-compliant party.
Said motion may be done without further notice to the non-compliant party. Such execution
by the Chief Clerk shall have the same effect as if executed by the non-compliant party.
Date Judge’s Signature
Print Judge’s Name:
APPROVED AS TO FORM AND CONTENT:
Signature of Plaintiff Signature of Defendant
Date Plaintiff Signed Decree: Date Defendant Signed Decree:
Social Security No.: XXX-XX- Social Security No.: XXX-XX-
Employer’s Name and Address: Employer’s Name and Address:
APPROVED AS TO FORM:
Signature of Attorney for Plaintiff Signature of Attorney for Defendant
Print Attorney’s Name: Print Attorney’s Name:
FC Adm 12/20/13
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