Get Hawaiian Registry

Hawaiian Registry Application Form Please type or print clearly. Complete this form in its entirety. All information will be kept confidential. FIRST NAME MIDDLE NAME HOME ADDRESS MAILING ADDRESS If different from home DAYTIME TELEPHONE NUMBER PRIMARY EMAIL ADDRESS DATE OF BIRTH MM/DD/YYYY PLACE OF BIRTH USE THIS 4 CHECKLIST q MALE FEMALE Check Box FOR OFFICE USE ONLY to confirm that you ve collected all required documents. hr OTHER NAMES USED i.e. birth name etc. oo LAST NAME Staff use only Ancestry Verification Application form for each applicant Signed and dated DO NOT FAX State Parental signature required for applicants 17 years of age and under Birth Certificate Number Date Registered w/DOH Note certificate stating Hawaiian Ancestry Photo ID to identify the applicant and a Color print or digital photograph for your new card You can e-mail ALL your documents save the photo as JPEG format and send to hireg oha.org IF YOUR BIRTH CERTIFICATE DOESN T STATE HAWAIIAN Provide document s that link your Hawaiian Additional information Ancestry through your biological parentage. Hawaiian Registry Application Form Please type or print clearly. Complete this form in its entirety. All information will be kept confidential* FIRST NAME MIDDLE NAME HOME ADDRESS MAILING ADDRESS If different from home DAYTIME TELEPHONE NUMBER PRIMARY EMAIL ADDRESS DATE OF BIRTH MM/DD/YYYY PLACE OF BIRTH USE THIS 4 CHECKLIST q MALE FEMALE Check Box FOR OFFICE USE ONLY to confirm that you ve collected all required documents. hr OTHER NAMES USED i*e* birth name etc* oo LAST NAME Staff use only Ancestry Verification Application form for each applicant Signed and dated DO NOT FAX State Parental signature required for applicants 17 years of age and under Birth Certificate Number Date Registered w/DOH Note certificate stating Hawaiian Ancestry Photo ID to identify the applicant and a Color print or digital photograph for your new card You can e-mail ALL your documents save the photo as JPEG format and send to hireg oha*org IF YOUR BIRTH CERTIFICATE DOESN T STATE HAWAIIAN Provide document s that link your Hawaiian Additional information Ancestry through your biological parentage. Adoption information can be obtained Family Court Division of Legal Research and Adoption Records In the circuit in which the adoption took place. 1st Oahu - 2nd Maui Moloka i and Lana i - 3rd Hawai i - 5th Kaua i. Original birth certificates can be obtained State of Hawai i - Department of Health Vital Records Section www. hawaii. gov/doh 808 586-4533 1250 Punchbowl Street Room 103 Honolulu HI 96813 Card Renewal Lost Damaged Expiried Date I certify that I am Hawaiian and that the above information contained on this form is true and correct to the best of my knowledge and belief* I further consent to and authorize the Hawaiian Registry staff to extract information to verify and to validate my Hawaiian ancestry from the Operation Ohana records along with the Department of Health other state repositories and Hawaiian organizations for the purpose herein and for verification and validation* Signature of registrant or legal guardian THIS APPLICATION AND THE DATA PROVIDED HEREIN ARE MAINTAINED BY THE OFFICE OF HAWAIIAN AFFAIRS* FROM TIME TO TIME WE MAY BE SENDING YOU INFORMATION AND ANNOUNCEMENTS OF THE OFFICE OF HAWAIIAN AFFAIRS PROGRAM AND SERVICES* THE OFFICE OF HAWAIIAN AFFAIRS WILL NOT SHARE DISCLOSE OR MAKE ACCESSIBLE YOUR PERSONAL REGISTRATION INFORMATION TO ANY OTHER AGENCY ORGANIZATION PERSON OR ENTITY WITHOUT YOUR EXPRESSED WRITTEN CONSENT EXCEPT AS REQUIRED BY LAW* Revised 02/22/11 Mail application to OFFICE OF HAWAIIAN AFFAIRS HAWAIIAN REGISTRY 711 Kapi olani Blvd.