FAMILY COURT FIRST CIRCUIT STATE OF HAWAI‘I In the Matter of A [ ] MALE [ Born on: A [ ] MALE [ Born on: A [ ] MALE [ Born on: by FINDINGS AND DECISION OF THE COURT GRANTING PETITION FOR ADOPTION [ [ the Adoption of ] FEMALE CHILD, CASE NUMBER FC-A No. ] ATTORNEY FOR PETITIONER(S) ] PETITIONER(S) PRO SE ] FEMALE CHILD, Name ] FEMALE CHILD, [ ] the legal spouse/partner of 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 The Petition for Adoption was heard in this Court on the date indicated above. The Petitioner(s) and their attorney indicated above, if any, appeared at the hearing. Pursuant to section 578-8 of the Hawai‘i Revised Statutes, the Director of Human Services was notified on of the pending adoption and has not intervened nor filed any negative reports regarding adoption. After consideration of the petition and the evidence adduced, including any report filed by the Department of Human Services, THE COURT FINDS the following facts concerning the child(ren) and the child(ren)’s parentage and availability for adoption by the Petitioner(s): CHILD(REN)’S LEGAL NAME SEX BIRTHDATE PLACE OF BIRTH B IR T H C E R TIFIC A TE N U M BE R CHILDREN’S NAMES AFTER ADOPTION: FC Adm 3/1/12 Reprographics (03/12)1F PAGE 1 COURT USE ONLY Findings and Decision of the Court Granting Petition for Adoption 1F-P-881 American LegalNet, Inc. www.FormsWorkFlow.com FAMILY COURT FIRST CIRCUIT STATE OF HAWAI‘I FINDINGS AND DECISION OF THE COURT GRANTING PETITION FOR ADOPTION MOTHER’S INFORMATION Present Name: Name at Child’s Birth: Marital Status at Child’s Birth: [ ] Single [ ] Legal Present Parental Status: CASE NUMBER FC-A No. [ ] Married [ ] Divorced [ ] Widowed [ ] Natural and Legal FATHER’S INFORMATION Name: [ ] Legal Present Parental Status: [ ] Natural [ ] Natural and Legal Name: Present Parental Status: [ ] Legal [ ] Natural [ ] Alleged Natural Name: [ ] Legal Present Parental Status: LEGAL GUARDIAN’S NAME: [ ] Natural [ ] Separated [ ] Alleged Natural [ ] Adjudicated LEGAL GUARDIAN’S NAME: PLACEMENT OF CHILD(REN) EFFECTED BY OTHER THAN OWN PARENT Name of Placing Agency: Date of Placement with Petitioner(s): PETITIONER(S) Relationship to Child(ren): Present Marital Status: [ ] Married to Child(ren)’s Parent [ ] In a Civil Union with Child(ren)’s Parent [ ] In a Civil Union with Co-Petitioner [ ] Single [ ] Married to Co-Petitioner CONSENT TO THIS ADOPTION WAS GIVEN BY THE FOLLOWING: [ ] Mother [ ] Legal Guardian [ ] Child, Age [ ] Natural and Legal [ ] Legal Custodian [ ] Child, Age [ ] Legal Father [ ] Adjudicated Father [ ] Child, Age [ ] Natural Father [ ] Alleged Father [ ] [ ] Adult Adoptee [ ] Adult Adoptee’s Spouse [ ] PERSON NOT CONSENTING: [ ] Mother [ ] Natural and Legal Father [ ] Legal Father [ ] Adjudicated Father [ ] Natural Father [ ] Legal Guardian [ ] Legal Custodian [ ] Consent Not Required on the Following Grounds: [ ] Consent Not Filed for the Following Reason: [ ] Parental Rights Terminated [ ] Parent( s) Deceased FC Adm 3/1/12 PAGE 2 OF 3 Findings and Decision of the Court Granting Petition for Adoption 1F-P-881 American LegalNet, Inc. www.FormsWorkFlow.com FAMILY COURT FIRST CIRCUIT STATE OF HAWAI‘I FINDINGS AND DECISION OF THE COURT GRANTING PETITION FOR ADOPTION CASE NUMBER FC-A No. IT IS THE FURTHER FINDING OF THE COURT that: The material allegations of the Petition for Adoption have been proved and that all the necessary consents have been obtained and filed in this case; The child(ren) is/are adoptable under the provisions of Chapter 578 of the Hawai‘i Revised Statutes and that all of the statutory requirements have been met; The child(ren) is/are physically, mentally, and otherwise suitable for adoption by the Petitioner(s), and it is in the best interest of the child(ren) that the adoption be granted; The Petitioner(s) is/are fit and proper person(s) financially able to provide the child(ren) with a proper home and education; [ ] (For Stepparent Adoption): The full reciprocal legal rights and duties existing between the child(ren) and the legal parent who is now the spouse or civil union partner of the Petitioner, be continued. All outstanding parental rights, inconsistent or incompatible with the adoptive parental rights shall be terminated. A Decree of Adoption terminating all outstanding parental rights inconsistent or incompatible with the adoptive parental rights acquired by said Petitioner(s) through this adoption and setting forth the name(s) of the child(ren) to be fixed by such Decree, shall be signed upon presentation and will take effect on the date indicated on page one. THE CLERK OF THE COURT IS AUTHORIZED TO CERTIFY AND ISSUE: Copies of the Decree to the attorney or pro se Petitioner(s). . Copy/copies of the Decree to Additional copies of these Findings to the attorney or pro se Petitioner(s). DATE JUDGE’S SIGNATURE Print Judge’s Nam e FC Adm 2/17/12 PAGE 3 OF 3 Findings and Decision of the Court Granting Petition for Adoption 1F-P-881 American LegalNet, Inc. www.FormsWorkFlow.com