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FAMILY COURT FIRST CIRCUIT STATE OF HAWAI221I SUPPORTING AFFIDAVIT (For Service by Mail or Personal Service Without the State) CASE NUMBER FC-A NO. In the Matter of Adoption of A [ ]MALE [ ]FEMALE CHILD, Born on: A [ ]MALE [ ]FEMALE CHILD, Born on: A [ ]MALE [ ]FEMALE CHILD, Born on: A [ ]MALE [ ]FEMALE CHILD, Born on: by [ ]the legal spouse of [ ]and [ ]the child(ren)'s legal parent [ ]husband and wife [ ]an unmarried person Petitioner(s). The undersigned being first duly sworn on oath, deposes and says that: This affidavit is made in support of the prayer of the petition that notice to the non-consenting [ ] mother [ ] father [ ] legal guardian [ ] legal custodian of the subject child be given by [ ] mail [ ] personal service without the state. The name of the non-consenting person/agency is: . The present address or the last known address of the non-consenting person/agency is as follows: . Signature of Petitioner State of Hawai221i, County of Honolulu: Signature: Printed Name of Notary Public: Commission Expires: Date Notary Public, State of Hawai221i SUPPORT AFFIDAVIT (For Service by Mail or Personal Service Without the State) 08/07/01 American LegalNet, Inc. www.FormsWorkFlow.com