IN THE FAMILY COURT OF THE FIRST CIRCUIT 002STATE OF HAWAII 002FC-A 002 In the Matter of the Adoption of A MALE/FEMALE CHILD, NO.Born on by Petitioner(s). 002THE STATE OF HAWAI221I TO: 002, whose last known address is: YOU ARE HEREBY NOTIFIED that a petition for adoption of the above-identified child(ren) born to , the child(ren)222 s mother, has been filed in the Family Court, First Circuit, State of Hawai221i. THE PETITION ALLEGES that your consent to the adoption of the above-named child(ren) by the Petitioner(s) above-named is not required and may be dispensed with pursuant to Hawai221i Revised Statutes Section 578-2(c) as amended. A hearing on the Petition will be held on at .m. at the Family Court located at the Kapolei Court Complex, 4675 Kapolei Parkway, Third Floor, Kapolei, Hawai221i. IF YOU FAIL to appear at the hearing on date and time and at the place noted above or if you fail to file a written response to the allegations reflected in the Petition for Adoption, further action may be taken including the granting of the adoption without further notice to you. Your written response should be addressed to the Presiding Judge, Family Court, First Circuit, Kapolei Court Complex, 4675 Kapolei Parkway, Kapolei, Page 1 of 2 Pages American LegalNet, Inc. www.FormsWorkFlow.com Hawai221i 96707-3272. FAILURE TO OBEY this notice may result in an entry of a default and default judgment against you. YOU ARE FURTHER NOTIFIED that the child, the adoptive parents and the natural parents have rights under H.R.S. Section 578-15 regarding confidentiality of adoption records after the child reaches age 18. DATED: Honolulu, Hawaii, . Clerk of the above-entitled Court Attorney/Petitioner(s)222s Name: 002Address: 002Name of Newspaper: 002Page 2 of 2 Pages American LegalNet, Inc. www.FormsWorkFlow.com