FAMILY COURT FIRST CIRCUIT STATE OF HAWAI`I CASE NUMBER EX PARTE MOTION AND AFFIDAVIT FOR CUSTODY OF CHILD(REN) PENDENTE LITE; ORDER FC-A No. In the Matter of the Adoption of A [ ] MALE [ ] FEMALE CHILD, Born on: A [ ] MALE [ ] FEMALE CHILD, Born on: A [ ] MALE [ ] FEMALE CHILD, Born on: by [ ] legal spouse of [ ] civil union partner of [ ] and [ ] ATTORNEY FOR PETITIONER(S) [ ] PETITIONER(S) PRO SE Name Address City, State, Zip Code Telephone Number [ ] the child(ren)'s legal parent [ ] a married couple [ ] civil union partners [ ] an unmarried person Petitioner(s). Email address EX PARTE MOTION AND AFFIDAVIT FOR CUSTODY OF CHILDREN PENDENTE LITE Comes now Petitioner(s) above-named and moves this Honorable Court for an order awarding the temporary custody of the above-identified child(ren) pendente lite to Petitioner(s). This motion is brought pursuant to Hawai`i Revised Statutes section 578-3, Rule 10 of the Hawai`i Family Court Rules and Rule 7(a) of the Rules of the Circuit Court. Petitioner(s) is/are requesting for a temporary custody order for the following reasons: The above-identified child(ren) was/were placed with the Petitioner(s) on . (Date) The child(ren)'s mother has signed a consent for the child(ren) to be adopted by Petitioner(s). The child(ren)'s [ ] natural and legal father [ ] natural father [ ] legal father has signed a consent for the children to be adopted by Petitioner(s). The adoption agency, which placed the child(ren) with Petitioner(s), has signed a selection and approval for the Petitioner(s) to adopt said child(ren). 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 1/13/16 COURT USE ONLY EX PARTE MOTION AND AFFIDAVIT FOR CUSTODY OF CHILD(REN) PENDENTE LITE; ORDER Page 1 of 2 Pages Reprographics (2/2016) 1F-P-1037 American LegalNet, Inc. www.FormsWorkFlow.com Section 508 Certified FAMILY COURT FIRST CIRCUIT STATE OF HAWAI`I EX PARTE MOTION AND AFFIDAVIT FOR CUSTODY OF CHILD(REN) PENDENTE LITE; ORDER CASE NUMBER FC-A No. It is in the child(ren)'s best interest that Petitioner (s) be awarded temporary custody of the child(ren) for following reasons: Date Signature of Petitioner Date Signature of Petitioner Doc. Title: Doc. Date: Ex Parte Motion and Affidavit for Custody of Child(ren) Pendente Lite; Order 2 was subscribed and sworn to me in Date: No. of Pages: the First Circuit, State of Hawai`i by Notary Public Signature: Print Notary's Name: My commission expires: SEAL ORDER The court having reviewed the Ex Parte Motion and Affidavit for Custody of Child(ren) Pendente Lite and good cause appearing thereof, IT IS HEREBY ORDERED that Petitioner(s) shall be entitled to retain the custody and control of the above-named child(ren) and shall be responsible for the care, maintenance, and support of the child(ren) including any necessary medical or surgical treatment, pending further order of the court. This Order shall be in effect from the filing of the Petition for Adoption of said child(ren) until entry of the adoption decree or until further order of the court. DATE SIGNATURE OF JUDGE OF THE ABOVE-ENTITLED COURT Print Judge's Name: FC Adm 1/13/16 Page 2 of 2 Pages EX PARTE MOTION AND AFFIDAVIT FOR CUSTODY OF CHILD(REN) PENDENTE LITE; ORDER American LegalNet, Inc. www.FormsWorkFlow.com