FAMILY COURT EX PARTE MOTION AND _________ CIRCUIT AFFIDAVIT FOR CUSTODY OF STATE OF HAWAI‘I CHILD(REN) PENDENTE LITE; ORDER 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: CASE NUMBER FC-A NO. [ ]ATTORNEY FOR PETITIONER(S) [ ]PETITIONER(S) PRO SE Name Address City, State, Zip Code by Telephone Number [ ]the legal spouse of [ ]and [ ]the child(ren)'s legal parent [ ]husband and wife [ ]an unmarried person Petitioner(s). Comes now Petitioner(s) above-named and moves this Honorable Court for an order awarding the temporary custody of the above-identified child(ren) pendente lite to Petitioner(s). This motion is brought pursuant to Hawai‘i Revised Statutes Section 578-3, Rule 7(b) of the Hawai‘i Family Court Rules and Rule 7(a) of the Rules of the Circuit Court. Petitioner(s) is/are requesting for a temporary custody order for the following reasons: . The above-identified child(ren) was/were placed with the petitioner(s) on The child(ren)’s mother has signed a consent for the child to be adopted by Petitioner(s). The child(ren)’s [ ]natural and legal father [ ]natural father [ ] legal father has signed a consent for the child(ren) to be adopted by Petitioner(s). The adoption agency, which placed the child(ren) with petitioner(s), has signed a selection and approval for the petitioner(s) to adopt said child(ren). 08/07/01 PAGE 1 OF 2 PAGES EX PARTE MOTION AND AFFIDAVIT FOR CUSTODY OF CHILD(REN) PENDENTE LITE; ORDER American LegalNet, Inc. www.FormsWorkflow.com FAMILY COURT ______ CIRCUIT STATE OF HAWAI‘I EX PARTE MOTION AND AFFIDAVIT FOR CUSTODY OF CHILD(REN) PENDENTE LITE; ORDER CASE NUMBER FC-A NO. It is in the child(ren)’s best interest that petitioner(s) be awarded temporary custody of the child(ren) for the following reasons: SIGNATURE OF PETITIONER(S): State of Hawai‘i, County of Honolulu: Date Signature: Printed Name of Notary Public: Commission Expires: Notary Public, State of Hawai‘i ORDER The court having reviewed the Ex Parte Motion and Affidavit for Custody of Child(ren) Pendente Lite and good cause appearing thereof, IT IS HEREBY ORDERED that Petitioner(s) shall be entitled to retain the custody and control of the child(ren) above-identified and shall be responsible for the care, maintenance and support of the child(ren) including any necessary medical or surgical treatment, pending further order of the court. This order shall be in effect from the filing of the petition for adoption of said child(ren) until the entry of the adoption decree or until further order of the court. DATE 08/04/01 SIGNATURE OF JUDGE OF THE ABOVE-ENTITLED COURT PAGE 2 OF 2 PAGES EX PARTE MOTION AND AFFIDAVIT FOR CUSTODY OF CHILD(REN) PENDENTE LITE; ORDER American LegalNet, Inc. www.FormsWorkflow.com