FAMILY COURTNOTICE TO DHS CASE NUMBERFIRST CIRCUITOF PENDENCY OF ACTION FC-A No.STATE OF HAWAI221I In the Matter of the Adoption of[]ATTORNEY FOR PETITIONER(S)A[]MALE CHILD[]FEMALE CHILD[]PETITIONER(S) PRO SEBorn on:A[]MALE CHILD[]FEMALE CHILDNameBorn on:NameA[]MALE CHILD[]FEMALE CHILDBorn on:AddressbyCity, State, Zip Code[]legal spouse of[]civil union partner of[]andTelephone Number[]the child(ren)222s legal parent[]a married couple[]civil union partners[]an unmarried personPetitioner(s).TO:DIRECTOR OF THE DEPARTMENT OF HUMAN SERVICESOR HIS/HER DESIGNEEO221ahu Child Welfare Services Section 3420 Waiakamilo Road, Suite 300AHonolulu, Hawai221i 96817Pursuant to Section 578-8(b) of the Hawai221i Revised Statutes, you are hereby notified that anadoption petition for the above-entitled matter has been filed and is pending before the Court. You have twenty-one (21) days from the receipt of this Notice to make such investigationand to file a written report as you may deem proper as to the fitness of thePetitioner(s) to adopt the individual(s) and as to whether the best interest ofthe individual(s) will be subserved by the adoption. Extensions of time maybe granted for good cause shown. Please direct all reports and requests forextensions to: Family Court, Attention: Adoption Clerk.DATE Clerk of the Court222s SignatureCOURT USE ONLYFC Adm 5/10/18NOTICE TO DHS OF PENDENCY OF ACTION1F-P-2028In accordance with the Americans with Disabilities Act, as amended, and other applicable state and federal laws, if you requireaccommodation for a disability, please contact the ADA Coordinator at the First Circuit Family Court office by telephone at954-8200, fax 954-8308, or via email at adarequest@courts.hawaii.gov at least ten (10) days prior to your hearing orappointment date.Please call the Family Court Service Center at 954-8290 if you have any questions about forms or procedures. American LegalNet, Inc. www.FormsWorkFlow.com