Ka Wai Ola - Office of Hawaiian Affairs, Volume 30, Number 8, 1 August 2013 — Page 35 Advertisements Column 2 [ADVERTISEMENT]

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Charmaine I. Quilit Poki REALTOR, GRI, CRS. CDPE Prudertial LeeaEione LLC Phone: (SŪ3) 73i-5043 Cell: (808) 295-4474 charmaire.quilitpcki@pru hawaii.com www.ChanriaineQuilītPol{i .Com Tha ūnest cowptiment I ean evar mcarve, is a mlenal fmnt my friends and CuSiomerS>

I want to be left off the transfer list. t , hereby instruct the Offīce of Hawaiian Affairs (OHA) to withhold my name and my other information when transferring information to the Native Hawaiian Roll Commission under the Act 77 transfer process. I hereby certify that I am 18years of age or older and that I am legally authorized to contract in my own name. Mail to: OHA-No roll; 71 1 Kapi'olani Blvd., Ste 500; Hon. Hl 96813. Nameon Birth Certificate (First, middle, last) Dateofbirth Mailing address City State Zip Phone Email Signature By signing this form, I releaseand discharge OHAfrom any and all liability, claims, and demands arising out of OHA's withholding of my nameand my other information based upon this written request, including the possible loss of rights and recognitions conferred upon members of theofficial roll created under Act 195.