[ ] Petitioner(s), Pro Se [ ] Attorney for Petitioner(s) IN THE FAMILY COURT OF THE SECOND CIRCUIT STATE OF HAWAI`I In the Matter of Adoption of ) FC-A NO. A [ ]MALE [ ]FEMALE ) Born on: ) FINDINGS AND DECISIONS A [ ]MALE [ ]FEMALE ) OF THE COURT GRANTING Born on: ) PETITION FOR ADOPTION A [ ]MALE [ ]FEMALE ) Born on: ) Presiding Judge: A [ ]MALE [ ]FEMALE ) Born on: ) ) by ) earing Date: Effective Date of Decree: ) ) [ ] the legal spouse of [ ] and ) ) ) [ ] the child(ren)222s legal parent ) [ ] husband and wife [ ] civil union partners ) [ ] an unmarried person )) Petitioner(s) ) FINDINGS AND DECISION OF THE COURT GRANTING PETITION FOR ADOPTION The Petition for Adoption was heard in this Court on the date indicated above. The Petitioner(s) and their attorney indicated above, if any, appeared at the hearing. Pursuant to section 578-8 of the Hawai`i Revised Statutes, the Director of Human Services was notified on of the pending adoption and has not intervened nor filed any negative reports regarding the adoption. American LegalNet, Inc. www.FormsWorkFlow.com After consideration of the petition and the evidence adduced, including any report filed by the Department of Human Services, THE COURT FINDS the following facts concerning the child(ren) and the child(ren)222s parentage and availability for adoption by Petitioner(s): CHILD(REN)222s LEGAL NAME SEX BIRTHDATE PLACE OF BIRTH BIRTH CERTIFICATE NUMBER CHILD(REN)222S NAMES AFTER ADOPTION: MOTHER222S INFORMATION: Present Name: Name at Child(ren)222s Birth: Marital Status at Child(ren)222s Birth: [ ] Single [ ] Married [ ] Divorced [ ] Widowed [ ] Separated Present Parental Status: [ ] Legal [ ] Natural and Legal FATHER222S INFORMATION: Name: Present Parental Status: [ ] Legal [ ] Natural [ ] Legal and Natural [ ] Adjudicated Name: Present Parental Status: [ ] Legal [ ] Natural [ ] Legal and Natural [ ] Adjudicated Name: Present Parental Status: [ ] Legal [ ] Natural [ ] Legal and Natural [ ] Adjudicated American LegalNet, Inc. www.FormsWorkFlow.com LEGAL GUARDIAN222S NAME: LEGAL GUARDIAN222S NAME: PLACEMENT OF CHILD(REN) EFFECTED BY OTHER THAN PARENT Name of Placing Agency: Date of Placement with Petitioner(s): PETITIONER(S): Relationship to Child(ren): Present Marital Status: [ ] Married to Child(ren)222s Parent [ ] In a Civil Union with Child(ren)222s Parent [ ] Single [ ] Married to Co-Petitioner [ ] In a Civil Union with Co-Petitioner CONSENT TO THIS ADOPTION WAS GIVEN BY THE FOLLOWING: [ ] Mother [ ] Legal Guardian [ ] Child, Age [ ] Natural and Legal [ ] Legal Custodian [ ] Child, Age [ ] Legal Father [ ] Adjudicated Father [ ] Child, Age [ ] Natural Father [ ] Alleged Father [ ] [ ] Adult Adoptee [ ] Adult Adoptee222s Spouse [ ] PERSON NOT CONSENTING: [ ] Mother [ ] Natural and Legal Father [ ] Legal Father [ ] Adjudicated Father [ ] Natural Father [ ] Legal Guardian [ ] Legal Custodian [ ] Consent Not Required on the Following Grounds: [ ] Consent Not Filed for the Following Reasons [ ] Parental Rights Terminated [ ] Parent(s) Deceased American LegalNet, Inc. www.FormsWorkFlow.com IT IS FURTHER FINDING OF THE COURT that: The material allegations of the Petition for Adoption have been proved and that all the necessary consents have been obtained and filed in this case; The child(ren) is/are adoptable under the provisions of Chapter 578 of the Hawai`i Revised Statutes and that all of the statutory requirements have been met; The child(ren) is/are physically, mentally, and otherwise suitable for adoption by the Petitioner(s), and it is in the best interest of the child(ren) that the adoption be granted; The Petitioner(s) is/are fit and proper person(s) financially able to provide the child(ren) with a proper home and education; [ ] (For Step-Parent Adoption): The full reciprocal legal rights and duties existing between the child(ren) and the legal parent who is now the spouse or civil union partner of the Petitioner, be continued. All outstanding parental rights, inconsistent or incompatible with the adoptive parental rights shall be terminated. A Decree of Adoption terminating all outstanding parental rights, inconsistent or incompatible with the adoptive parental rights acquired by said Petitioner(s) through this adoption and setting forth the name(s) of the child(ren) to be fixed by such Decree, shall be signed upon presentation and will take effect on the date indicated on page one. THE CLERK OF THE COURT IS AUTHORIZED TO CERTIFY AND ISSUE: Copies of the Decree to the attorney or pro se Petitioner(s) Copy/copies of the Decree to Additional copies of these Findings to the attorney or pro se Petitioner(s) Date Signature of Judge In accordance with the Americans with Disabilities Act, as amended, and other applicable state and federal laws, if you require an accommodation for a disability, please contact the ADA Coordinator at the Family Court Administration Office at PHONE NO. 244-2700, FAX 244-2704 OR email adarequest@courts.hawaii.gov at least ten (10) working days before your proceeding, hearing or appointment date. American LegalNet, Inc. www.FormsWorkFlow.com