Haw. Prob. R. Flag Sheet 1-A

Probate No.

(Attorney for Petitioner or Pro Se Petitioner)

Tel. No. Estate of

I. Death Certificate

The death certificate actually shows the following information:

1. Name of decedent in full:

2. Date of death:

3. Marital status:

II. Publication Notice

1. Name of decedent as actually published

2. Dates of actual publication (in 3 consecutive weeks):

; ; .

III. Affidavit of Attesting Witness for Wills and Codicils

HRS §560:2-502(b) provides that a will may be valid as a holographic will “whether or

not witnessed, if the signature and material portions of the document are in the testator’s

handwriting.”

Is this will presented as a holographic will? Yes No

If “No,” continue. If “Yes,” you may skip to section IV.

(Note: No affidavit is required for a self-proved will or codicil. If the will or codicil is

not self-proved, one (1) properly executed affidavit of attesting witness is required for

each will and codicil. The affidavit should include the mandatory language that the

“decedent appeared to be of sound mind and under no constraint or undue influence at

the time of the execution of the said document.” In the absence of the affidavit of

attesting witness, oral testimony is required.)

1. Is the will or codicil self-proved? Yes No

2. If “No,” state the name of the attesting witness: .

3. Proof of will or codicil is by

Affidavit: Yes No

Oral testimony: Yes No

IV. Proof of Service

1. List or attach a list of all interested persons who are entitled to notice of hearing,

and their relationship to the decedent.

Name Relationship

2. Was notice served on all interested persons?

(HRS §560:1-401) Yes No

3. If “No,” were waivers of notice obtained and filed for all

interested persons other than those served under 2 above? Yes No

4. If “No,” list the names of all interested persons who have not been served and

have not waived notice.

V. Appointment of Personal Representative (PR) and Bond

1. Does the petition name the person with the highest priority? Yes No

2. If “No,” list or attach a list of the name of those persons who have higher or equal

priority with the proposed PR, and whether their renunciation and consent to the

appointment of the proposed PR have been obtained and filed.

Consent to Appointment Filed?

Name Yes No

3. Does the petition request the appointment of the

proposed PR without bond? Yes No

If “Yes,” is bond waived by will?Yes No

If bond is not waived by will, state the reason for this request and include the

relationship of the proposed PR to the decedent or beneficiaries.

4. If the appointment of the PR is with bond, state the amount

of the bond requested. $ .

VI. Prayer for Special Matters

(Note: Anything beyond the normal and ordinary probate matters shall be specified in this

classification as special or unusual matters.)

1.Special matters requested? Yes No

2. If “Yes,” enumerate such special matters.

VII. Objection or Opposition

1. Are you aware of any opposition or objection to this petition? Yes No

2. If “Yes,” state by whom (include the relationship of the objector to the decedent

or beneficiaries) and the grounds for the objection, if known.

THE UNDERSIGNED HEREBY CERTIFIES THAT TO THE BEST OF SAID

INDIVIDUAL’S KNOWLEDGE AND BELIEF ALL OF THE FOREGOING FACTS

AND FIGURES ARE TRUE AND CORRECT.

____________________________________

Attorney for Petitioner or Pro Se Petitioner

Hearing Date: