Form 2f-E-338 - Custody/visitation Statement
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1CASE NUMBER
STATE OF HAWAI‘I
CUSTODY / VISITATION
FAMILY COURT
STATEMENT
OF THE SECOND CIRCUIT
FC- ______ NO. _______________
1. The parties are the parents of:
____________________________________________________ born ____________________________
____________________________________________________ born ____________________________
____________________________________________________ born ____________________________
____________________________________________________ born ____________________________
2. The child/ren whose custody/visitation is at issue (“the subject child/ren”) is/are: _____________________
_____________________________________________________________________________________
3. The current address(es) of the subject child/ren is/are: __________________________________________
_____________________________________________________________________________________
4. The address(es) where the subject child/ren has/have lived in the past five (5) years are: _______________
_____________________________________________________________________________________
_____________________________________________________________________________________
5. The name(s) and current address(es) of the person(s) with whom the subject child/ren has/have lived within
the last five (5) years is/are: _______________________________________________________________
_____________________________________________________________________________________
6. [ ] I have not participated in the past as a party, witness, or in any other capacity in any litigation in Hawai‘i
or elsewhere involving the subject child/ren.
[ ] Other litigation involving the subject child/ren (including both those in which I have participated as a
party, witness, or in any other capacity, as well as those in which I have not participated) has been as
follows:
Case name _____________________________________________________________________________
Case number ___________________________________________________________________________
Location of Court _______________________________________________________________________
Date filed ___________________ Date concluded ____________________
Type of case
7. [ ] I do not know of any custody proceeding currently pending in Hawai‘i or elsewhere involving the
subject child/ren.
[ ] The following proceedings involving the subject child/ren are currently pending in Hawai‘i/elsewhere:
Case name _____________________________________________________________________________
Case number ___________________________________________________________________________
Location of Court _______________________________________________________________________
Date filed _____________________________________________________________________________
Type of case ___________________________________________________________________________
8. [ ] I do not know of any person not a party to this case who is not identified in paragraph 5. above and who
(a) has had the physical custody of the subject child/ren in the past and/or (b) claims to have custody/
visitation rights with respect to the subject child/ren.
[ ] The following other person(s) has/have had the physical custody of the subject child/ren and/or is/are
claiming custody/visitation rights: __________________________________________________________
_____________________________________________________________________________________
_________________________________________
_____________________________________
Movant’s signature
Date
(
)
Reprographics (01/12)
CLEAR FORM
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