Name (and if attorney, Attorney222s Number) Address City, State, Zip Code Telephone Number037 ~ Attorney for ~ Petitioner037 IN THE FAMILY COURT OF THE FIRST CIRCUIT STATE OF HAWAI221I In the Matter of the Guardianship of ) FC-G No. ) ) NOTICE OF APPOINTMENT OF ) GUARDIAN AND NOTICE OF RIGHT , ) TO REQUEST MODIFICATION OR(Full Legal Name) ) TERMINATION; CERTIFICATE OF An Incapacitated Person. ) SERVICE ) NOTICE OF APPOINTMENT OF GUARDIAN AND037 NOTICE OF RIGHT TO REQUST MODIFICATION OR TERMINATION037 STATE OF HAWAI221I TO: (List names and addresses of the Incapacitated Person and all parties in037 paragraphs 3-11 of the Petition.)037 Name and Address: Name and Address: In accordance with the Americans with Disabilities Act, as amended, and other applicable state and federal laws, if yourequire reasonable accommodation for a disability, please contact the ADA Coordinator at the First Circuit Family Courtoffice by telephone at 954-8200, fax 954-8308, or via email at 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 regarding forms or procedures. Notice of Appointment of Guardian and Notice of FC Adm 2/27/14 PAGE 1 OF 4 PAGES Right to Request Modification or Termination Name and Address: Name and Address: Name and Address: Name and Address: Name and Address: Name and Address: Name and Address: Name and Address: Notice is hereby given that has been (Name of Guardian) appointed by the Court to be the guardian . (Name of Incapacitated Person) You have a right to request the termination or modification of the attached Order Appointing Guardian with ~Limited ~Unlimited Authority by filing a written petition to Notice of Appointment of Guardian and Notice of FC Adm 2/27/14 PAGE 2 OF 4 PAGES Right to Request Modification or Termination terminate or modify the guardianship order and notice of hearing with the Office of the Chief Court Administrator of the First Circuit Court, c/o Legal Documents Branch whose location and mailing address is Ronald T.Y. Moon Kapolei Courthouse, 4675 Kapolei Parkway, Kapolei, Hawai221i, 96707 or Ka221ahumanu Hale, 777 Punchbowl Street, Honolulu, Hawai221i, 96813. File-stamped copies of this Petition to Terminate or Modify the Guardianship and a Notice of Hearing must be mailed to the Guardian at the following mailing address: and to the Ward and all other parties at the addresses noted above. DATED: Kapolei, Hawai221i, . Signature of Guardian Notice of Appointment of Guardian and Notice of FC Adm 2/27/14 PAGE 3 OF 4 PAGES Right to Request Modification or Termination IN THE FAMILY COURT OF THE FIRST CIRCUIT037 STATE OF HAWAI221I 037In the Matter of the Guardianship of036 ) FC-G No.037 )037 ) CERTIFICATE OF SERVICE ) ,)037 (Full Legal Name) )037 An Incapacitated Person. ) ) CERTIFICATE OF SERVICE I hereby certify that, on the date noted below, I caused to be mailed to the below-named persons, copies of the attached document: DATE OF NAME ADDRESS SERVICE DATED: Kapolei, Hawai221i, . Signature of Person Certifying Service Print Complete Name Notice of Appointment of Guardian and Notice of FC Adm 2/27/14 PAGE 4 OF 4 PAGES Right to Request Modification or Termination