FAMILY COURT _______________ CIRCUIT STATE OF HAWAI‘I AFFIDAVIT OF ADOPTIVE PARENT(S) (RE: HRS SECTION 578-15) CASE NUMBER FC-A NO. [ ]ATTORNEY FOR PETITIONER(S) [ ]PETITIONER(S) PRO SE 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: Name by Address City, State, Zip Code [ ]the legal spouse of [ ]and Telephone Number [ ]the child(ren)'s legal parent [ ]husband and wife [ ]an unmarried person Petitioner(s). STATE OF HAWAI‘I CITY AND COUNTY OF HONOLULU ) ) ) SS. Petitioner(s) above-named being first duly sworn on oath, deposes and says that: 1. I have been advised of the requirements of Section 578-15 of the Hawai‘i Revised Statutes regarding confidentiality of the court's adoption files and will be able to give this information to the child(ren) I will be adopting; 2. When an adopted child becomes 18 years old, the child or the child's adopted parents can request, in writing, to see the court's files regarding this adoption. 3. If the child's natural parents want to keep their identity confidential, each natural parent must file an affidavit requesting confidentiality with the Family Court, where the adoption took place, within ninety (90) calendar days before the child's 18th birthday. 4. This affidavit requesting confidentiality is good for ten (10) years. After that, the natural parents can file affidavits every ten (10) years or they can file an affidavit which keeps their identity confidential for the rest of their lives. All affidavits must be filed within ninety (90) calendars days prior to the expiration of the previous affidavit. 08/07/01 PAGE 1 OF 2 PAGES AFFIDAVIT OF ADOPTIVE PARENT(S) (RE: HRS §578-15) American LegalNet, Inc. www.FormsWorkflow.com FAMILY COURT ______ CIRCUIT STATE OF HAWAI‘I AFFIDAVIT OF ADOPTIVE PARENT(S) (RE: HRS SECTION 578-15) CASE NUMBER FC-A NO. 5. The child's natural parents can request to see the child's adoption file, too, but the child has the same rights to confidentiality. 6. If a child wants his or her identity to be kept confidential, the child must file an affidavit requesting confidentiality within ninety (90) days prior to his or her 18th birthday. This affidavit is good for ten (10) years. After that, the child can file an affidavit every ten (10) years or the child can file an affidavit to cover the rest of the child's life. 7. One natural parent's action can only bind that one parent and will not apply to the other. 8. The natural parents can agree to open up the child's adoption file at any time and the child can, too, anytime after turning 18 years old. 9. If after turning 18, the child wants his or her identity revealed, it will be the child's responsibility to contact the Family Court (on the island where the adoption was granted), in writing, and let the Family Court know his or her current address. 10. Notwithstanding any affidavits requesting confidential, the child or the adoptive parents can obtain information in the records concerning the child's ethnic background and medical history. 11. The Family Court has no responsibility to notify the child, adoptive parents, or the natural parents of any deadlines or expiration dates. Signature of Petitioner State of Hawai‘i, County of Honolulu Signature: Date Printed Name of Notary Public: Notary Public, State of Hawai‘i Commission Expires: Date Signature of Petitioner State of Hawai‘i, County of Honolulu Signature: Date 08/07/01 PAGE 2 OF 2 PAGES Notary Public, State of Hawai‘i Printed Name of Notary Public: Commission Expires: Date AFFIDAVIT OF ADOPTIVE PARENT(S) (RE: HRS §578-15) American LegalNet, Inc. www.FormsWorkflow.com