Name, Address & Phone Number (If Attorney filing, type Name, Address & Phone Number) [ ] 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: ) SUPPORTING AFFIDAVIT A [ ]MALE [ ]FEMALE ) Born on: ) (For Service by Mail or Personal A [ ]MALE [ ]FEMALE ) Service Without the State) Born on: ) A [ ]MALE [ ]FEMALE ) Born on: ) ) by ) ) ) [ ] the legal spouse of [ ] and ) ) ) [ ] the child(ren)222s legal parent ) [ ] husband and wife [ ] civil union partners ) [ ] an unmarried person ) ) Petitioner(s) ) SUPPORTING AFFIDAVIT (For Service by Mail or Personal Service Without the State) 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 American LegalNet, Inc. www.FormsWorkFlow.com non-consenting [ ] mother [ ] father [ ] legal guardian [ ] legal custodian of the subject child(ren) was 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(s) Subscribed and sworn to me before on this day of , 20 Notary Public, Judicial Circuit State of Hawai222i My Commission expires: 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