Hawaiian Kingdom Government

Ua mau ke ea o ka aina i ka pono

(The sovereignty of the land is perpetuated in righteousness)

KINGDOM HEIR INHERITANCE

1) Monthly Monetary Inheritance 2) HealthCare (healthcare, dental, vision, prescription, alternative health care-lomilomi, shiatsu, acupuncture etc.) 3) Housing (residential, agriculture, pastoral and/or aquaculture) 4) Education (includes cost of: ALL meals, uniform, books, excursions, tutoring, transportation, and tuition) 5) Government Job Opportunities & Training (career in the Hawaiian Kingdom Govt) 6) Free Transit 7) Day Care (infants & toddlers up to age 3, na kupuna) 8) Free Burial Plot 9) Monthly Food Allowance 10) Monthly Clothing Allowance 11) Monthly Gas Allowance ($100.00 per car x2 cars) 12) No Wage Tax Instructions & Check List
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(1)Personal Information Attach a copy of your Birth Certificate who is the main Recipient and Spouse or BIOLOGICAL parent of child(ren). Also if your spouse is deceased, attach copy of his/her Death Certificate. If you do not have a copy of the Death Certificate, you may provide a Certificate of Live Birth (Birth Certificates). FYI: Ethnicity is Poe Kanaka (2Family Information Attach Birth Certificates for EACH child. If you are the Adoptee or Legal Guardian, please include a copy of Decree. BIOLOGICAL certificate(s) of child(ren) is needed. (3)Family Information (Child Name Change) If you legally change a childs name, attach Certificate o f Live Birth with the name change. (4)Family Information (Father) Attach Death Certificate or Live Birth of BIOLOGICAL father. (5)Family Information (Mother) Attach Death Certificate or Live Birth of BIOLOGICAL mother. (6)Criminal Background Information Attach change of name decree with the date verifying the change. The Hawaiian Kingdom Govt will conduct an investigation on all persons filling out this form to verify all answers. (7)Residency Information Please fill in the information to the best of your knowledge. No attachments required. (8)Educational Information Please fill in the information to the best of your knowledge. No attachments required. (9)Employment Information Please fill in the information to the best of your knowledge. No attachments required. (10)Signature and Date Sign your signature. Any unsigned form will be returned. Identification/Statistics Please submit a copy of your drivers license or identification card which has all your statistics on the card. If not, you can fill out the form which is provided.

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Hawaiian Kingdom Government

Kingdom Heir Profile Personal Information: [1]
Full Name: LAST, FIRST, MIDDLE (MAIDEN) Present Address: Street Address, Apartment No. City/State/Zip: Nationality: Ethnicity: Birth Date: Age:______ Birth Place: Home Telephone: Business Telephone: Cellular Telephone: Fax: E-mail: ___Single ___Married ___Divorced ___Widow ___Widower

Spouses Full Name: LAST, FIRST, MIDDLE Present Address: City/State/Zip: Nationality: Ethnicity: Home Telephone: ___Living ___Deceased Date Deceased: __________________

If deceased, please provide a certified copy of the Certificate of Death.

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Hawaiian Kingdom Government

Family Information: [2]
List ALL children starting with the eldest. If you are an Adoptive Parent or Legal Guardian, please provide a certified copy of the Adoption or Legal Guardianship Decree along with the children(s) certified Certificate of Live Birth. Childs Name: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Birth Date
Age Biological Parent Adoptive Parent Legal Guardian

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Hawaiian Kingdom Government

Family Information: (Child Name Change) [3]
If you at any time legally changed your children(s) name, please provide that information below along with a certified copy (eg. Adoption or Legal Guardianship Decree along with certified Certificate of Live Birth) showing the name change. List accordingly from eldest to youngest etc. Child(ren): 1. Lodial Name: 2. Name Change: 1. Lodial Name: 2. Name Change: 1. Lodial Name: 2. Name Change: 1. Lodial Name: 2. Name Change: 1. Lodial Name: 2. Name Change: 1. Lodial Name: 2. Name Change: 1. Lodial Name: 2. Name Change: 1. Lodial Name: 2. Name Change: 1. Lodial Name: 2. Name Change: Date Changed

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Hawaiian Kingdom Government

Family Information: (continue) [4]
Fathers Full Name: FIRST, MIDDLE, LAST ___Biological Present Address: Street Address, Apartment No. City/State/Zip: Nationality: Ethnicity: Birth Date: Age:_______ Birth Place: Home Telephone: Business Telephone: Cellular Telephone: ___Step-Father ___Legal Guardian

___Living

___Deceased

If deceased, please provide a certified copy of the Certificate of Death. Employer: Position: Length of Employment: Please list any special skills, talents, background:

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Hawaiian Kingdom Government

Family Information: (continue) [5]
Mothers Full Name: FIRST, MIDDLE, LAST ___Biological Present Address: Street Address, Apartment No. City/State/Zip: Nationality: Ethnicity: Birth Date: Age:_______ Birth Place: Home Telephone: Business Telephone: Cellular Telephone: ___Step-Mother ___Legal Guardian

___Living

___Deceased

If deceased, please provide a certified copy of the Certificate of Death. Employer: Position: Length of Employment: Please list any special skills, talents, background:

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Hawaiian Kingdom Government

Criminal Background Information: [6]
Have you ever been arrested: _____yes If yes, explain: _____no

Have you ever been convicted:_____yes _____no If yes, explain:

Have you ever served prison time:_____yes _____no How long: _____years _____months _____day(s) Are you currently on probation: _____yes _____no If yes, how long: _____year(s) _____month(s) _____day(s) Are you currently free on bail: _____yes _____no Date trial begins:

Other Information:
Do you have an alias name: _____yes _____no If yes, please provide:

Did you at anytime legally change your name: _____yes _____no If yes, please provide change with date:

Any visible marks: (eg. scars or tattoos)

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Hawaiian Kingdom Government

Residency Information: [7]
Please start with your present residence. 1. Address: Length of Residency: ___Rent ___Apartment Reason for Leaving: ___Own ___Condominium ___Home

2. Address: Length of Residency: ___Rent ___Apartment Reason for Leaving: ___Own ___Condominium ___Home

3. Address: Length of Residency: ___Rent ___Apartment Reason for Leaving: ___Own ___Condominium ___Home

4. Address: Length of Residency: ___Rent ___Apartment Reason for Leaving: ___Own ___Condominium ___Home

5. Address: Length of Residency: ___Rent ___Apartment Reason for Leaving: ___Own ___Condominium ___Home

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Hawaiian Kingdom Government

Educational Information: [8]
Pre-School: Any Certificates: _____yes _____no Elementary School: Any Certificates: _____yes _____no Intermediate School: Any Certificates: _____yes _____no High School: Year Graduated:

College: Year Attended: Majored in: Year Graduated:

University: Year Attended: Majored in: Year Graduated:

Business College: Year Attended: Majored in: Year Graduated:

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Hawaiian Kingdom Government

Employment Information: [9]
Please start with your present employer. 1. Name of Employer or Company: Address: Telephone Number: Position: Length of Employment: _____Full-Time _____Part-Time _____Semi-Retired Reason for Leaving:

2. Name of Employer or Company: Address: Telephone Number: Position: Length of Employment: _____Full-Time _____Part-Time _____Semi-Retired Reason for Leaving:

3. Name of Employer or Company: Address: Telephone Number Position: Length of Employment: _____Full-Time _____Part-Time _____Semi-Retired Reason for Leaving:

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Hawaiian Kingdom Government

I do hereby acknowledge with my signature below, that the information provided is true and correct to the best of my ability and understand if said document has been falsified or altered will result in serious consequences under the Hawaiian Kingdom Laws.

Registered Individual

Date

: KII.

: MEHEU-MANAMANA-KUHI.

: KOKO.

FOR GOVERNMENT OFFICIAL USE ONLY

Date Received: Processed By: Title:

_____Approved _____Denied If denied, specify:

Date Approved: Approved By: Royal Minister of Foreign Affairs

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