FAMILY COURT FIRST CIRCUIT STATE OF HAWAI`I A [ ] MALE Born on: A [ ] MALE Born on: A [ ] MALE Born on: [ [ [ by [ ] the legal spouse/partner of ADOPTION DECREE [ ] BY OTHER THAN STEPPARENT [ ] BY STEPPARENT CASE NUMBER FC-A No. In the Matter of the Adoption of ] FEMALE CHILD, ] FEMALE CHILD, [ ] ATTORNEY FOR PETITIONER(S) [ ] PETITIONER(S) PRO SE Name ] FEMALE CHILD, Address [ ] and City, State, Zip Code [ ] the child(ren)'s legal parent [ ] husband and wife [ ] civil union partners [ ] an unmarried person Petitioners. PRESIDING JUDGE Telephone Number HEARING DATE EFFECTIVE DATE OF DECREE This action was heard in this court on the date indicated above. Following the hearing and after full consideration of the evidence, the court found the material allegations of the petition for adoption to be for the best interest of the child(ren) and the court to have jurisdiction in this matter. IT IS ORDERED, ADJUDGED, AND DECREED that: CHILD'S NAME AFTER ADOPTION BIRTHDATE As of the effective date of this Decree, the child(ren) is/are decreed to be the petitioner(s)'s child(ren). As of the effective date of this Decree, the adopted child(ren) and adopting parent(s) shall sustain the legal relationship of child(ren) and parent(s) and shall have all rights and be subject tot he duties of that relationship, as if the child(ren) were the natural child(ren) of the adopting parent(s). All rights and duties between the child(ren) and [ ] any other person having a parental relationship to said child(ren) shall be deemed to have ceased. [ ] any person other than the legal spouse of the Petitioner shall be deemed to have ceased. However, the full reciprocal legal rights and duties, including the right of inheritance existing between the child(ren) and their legal parent, who is now married or a civil union partner to the Petitioner, shall continue, subject only to the rights acquired by and the duties imposed upon the Petitioner by this decree. The effective date of this Decree of Adoption is indicated above. DATE SIGNATURE OF JUDGE COURT USE ONLY Reprographics (03/12)1F FC A dm 2/17/12 A D O P TIO N D E C R E E American LegalNet, Inc. www.FormsWorkFlow.com 1F-P-880