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FAMILY COURT FIRST CIRCUIT STATE OF HAWAI`I In the Matter of the Adoption of A[ ] MALE [ [ [ ] FEMALE CHILD, ] FEMALE CHILD, ] FEMALE CHILD, Born on: A [ ] MALE Born on: A [ ] MALE Born on: LIST OF EXHIBITS [ ] SUPPLEMENTAL CASE NUMBER FC-A No. [ ] ATTORNEY FOR PETITIONER(S) [ ] PETITIONER(S) PRO SE Name Address by [ ] legal spouse of [ ] civil union partner of [ ] and [ ] the child(ren)'s legal parent [ ] a married couple [ ] civil union partners [ ] an unmarried person Petitioner(s). Exhibit No. City, State, Zip Code Telephone Number Email Address Description of Exhibit 1 Date Signature of Petitioner Pro Se or Attorney for Petitioner COURT USE ONLY Ho`okele/FC Adm 9/30/16 Reprographics (10/2016) 1F-P-1057 LIST OF EXHIBITS 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. Section 508 Certified American LegalNet, Inc. www.FormsWorkFlow.com FAMILY COURT FIRST CIRCUIT STATE OF HAWAI`I Exhibit No. LIST OF EXHIBITS [ ] SUPPLEMENTAL CONTINUATION SHEET Description of Exhibit CASE NUMBER FC-A No. Ho`okele/FC Adm 9/30/16 LIST OF EXHIBITS CONTINUATION SHEET American LegalNet, Inc. www.FormsWorkFlow.com