FAMILY COURT FIRST CIRCUIT STATE OF HAWAI`I AFFIDAVIT OF ADOPTIVE PARENT(S) (RE: HRS SECTION 578-15) CASE NUMBER FC-A No. In the Matter of the Adoption of A[ ] MALE [ [ [ [ by ] FEMALE CHILD, ] FEMALE CHILD, ] FEMALE CHILD, ] FEMALE CHILD, Born on: A [ ] MALE Born on: A [ ] MALE Born on: A [ ] MALE Born on: [ ] ATTORNEY FOR PETITIONER(S) [ ] PETITIONER(S) PRO SE Name Address City, State, Zip Code Telephone Number [ [ [ [ ] legal spouse of [ ] civil union partner of [ ] and ] the child(ren)'s legal parent ] a married couple [ ] civil union partners ] an unmarried person E-Mail Address Petitioner(s). STATE OF HAWAI`I CITY AND COUNTY OF HONOLULU ) ) SS. ) Petitioner(s) above-named being first duly sworn on oath, deposes and says that: 1. I have been advised of the requirements of Section 578-15 of the Hawai`i Revised Statutes (HRS) regarding confidentiality of the court's adoption files and will be able to give this information to the child(ren) I will be adopting; 2. When an adopted child becomes 18 years old, the child(ren) or the child(ren)'s adopted parent(s) can request, in writing, to see the court's files regarding this adoption. 3. If the child(ren)'s natural parent(s) want(s) to keep his/her/their identity confidential, each natural parent must file an affidavit requesting confidentiality with the Family Court, where the adoption took place, within ninety (90) calendar days before the child(ren)'s 18th birthday. 4. This affidavit requesting confidentiality is good for ten (10) years. After that, the natural parent(s) can file affidavits every ten (10) years or they can file an affidavit which keeps their identity confidential for the rest of their lives. All affidavits must be filed within ninety (90) calendar days prior to the expiration of the previous affidavit. COURT USE ONLY In accordance with the Americans with Disabilities Act, as amended, and other applicable state and federal laws, if you require accommodation for a disability, please contact the ADA Coordinator at the First Circuit Family Court office by telephone at 954-8200, fax 954-8308, or adarequest@courts.hawaii.gov at least ten (10) working days prior to your hearing or appointment date. Please call the Family Court Service Center at 954-8290 if you have any questions about procedures or how to fill out this form. FC Adm 1/5/16 Reprographics (1/2016) Page 1 of 2 Pages Affidavit of Adoptive Parents (RE: HRS §578-15) 1F-P-1031 American LegalNet, Inc. www.FormsWorkFlow.com Section 508 Certified FAMILY COURT FIRST CIRCUIT STATE OF HAWAI`I 5. 6. AFFIDAVIT OF ADOPTIVE PARENTS (RE: HRS SECTION 578-15) CASE NUMBER FC-A No. The child(ren)'s natural parents can request to see the child(ren)'s adoption file, too, but the child(ren) has/have the same rights to confidentiality. If a child wants his or her identity to be kept confidential, the child must file an affidavit requesting confidentiality within ninety (90) days prior to his or her 18th birthday. This affidavit is good for ten (10) years . After that, the child can file an affidavit every ten (10) years or the child(ren) can file an affidavit to cover the rest of the child(ren)'s life. One natural parent's action can only bind that one parent and will not apply to the other. The natural parents can agree to open up the child(ren)'s adoption file at any time and the child(ren) can, too, anytime after turning 18 years old. If after turning 18, the child(ren) want(s) his/her/their identity revealed, it will be the child(ren)'s responsibility to contact the Family Court (on the island where the adoption was granted), in writing, and let the Family Court know his/her/their current address. 7. 8. 9. 10. Notwithstanding any affidavits requesting confidentiality, the child(ren) or the adoptive parent(s) can obtain information in the records concerning the child(ren)'s ethnic background and medical history. 11. The Family Court has no responsibility to notify the child(ren), adoptive parent(s), or the natural parent(s) of any deadlines or expiration dates. Date Signature of Petitioner Affidavit of Adoptive Parents (RE: HRS Section 578-15) Doc. Date: No. of Pages: 2 was subscribed and sworn to before me in the First Circuit, State of Hawai`i by: Doc. Title: Notary Public Signature: Print Name: My commission expires: Date: SEAL Date Signature of Petitioner Affidavit of Adoptive Parents (RE: HRS Section 578-15) Doc. Date: No. of Pages: 2 was subscribed and sworn to me in the First Circuit, State of Hawai`i by: Doc. Title: Notary Public Signature: Print Name: My commission expires: FC Adm 1/5/16 Date: SEAL Page 2 of 2 Pages Affidavit of Adoptive Parents (RE: HRS §578-15) American LegalNet, Inc. www.FormsWorkFlow.com