FAMILY COURT ________ CIRCUIT STATE OF HAWAI‘I FINDINGS AND DECISION OF THE COURT GRANTING PETITION FOR ADOPTION 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 by City, State, Zip Code Telephone Number [ ]the legal spouse of [ ]and Hearing Date [ ]the child(ren)'s legal parent [ ]husband and wife [ ]an unmarried person Effective Date of Decree Presiding Judge Petitioner(s). 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 HRS §578-8, the director of human services was notified on of the pending adoption and has not intervened nor filed any negative reports regarding adoption. 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)’s parentage and availability for adoption by the petitioner(s): CHILD(REN)’S LEGAL NAME SEX BIRTHDATE PLACE OF BIRTH BIRTH CERTIFICATE NUMBER 9M 9F 9M 9F 9M 9F 9M 9F CHILD(REN)’S NAMES AFTER ADOPTION FOR COURT USE ONLY 05/20/02 PAGE 1 OF 3 PAGES FINDINGS AND DECISION OF THE COURT GRANTING PETITION FOR ADOPTION American LegalNet, Inc. www.FormsWorkflow.com FAMILY COURT ______ CIRCUIT STATE OF HAWAI‘I FINDINGS AND DECISION OF THE COURT GRANTING PETITION FOR ADOPTION FC-A No. MOTHER’S INFORMATION Present Name: Name at Child’s Birth: Marital Status at Child’s Birth: 9 Single 9 Married 9 Divorced 9 Widowed 9Separated Present Parental Status 9 Legal 9Natural and Legal FATHER’S INFORMATION Name: Present Parental Status: 9 Legal 9Natural 9Natural and Legal 9 Adjudicated Name: Present Parental Status: 9 Legal 9 Alleged Natural Name: Present Parental Status: 9 Legal 9 Alleged Natural LEGAL GUARDIAN’S NAME: LEGAL CUSTODIAN’S NAME: PLACEMENT OF CHILD(REN) EFFECTED BY OTHER THAN OWN PARENT Name of Placing Agency: Date of Placement with Petitioner(s): PETITIONER(S) Relationship to Child(ren): Present Marital Status: 9 Married to Child(ren)’s Parent 9 Married to Co-Petitioner 9 Single CONSENT TO THIS ADOPTION WAS GIVEN BY THE FOLLOWING: 9 Mother 9 Legal Guardian 9 Child, Age 9 Natural and Legal Father 9 Legal Custodian 9 Child, Age 9 Legal Father 9 Adjudicated Father 9 Child, Age 9 Natural Father 9 Alleged Father PERSON NOT CONSENTING: 9 Mother 9 Natural and Legal Father 9 Natural Father 9 Legal Guardian 9 Legal Father 9 Adjudicated Father 9 Legal Custodian 9 Consent Not Required on the Following Grounds: 9 Consent Not Filed for the Following Reason: 9 Parental Rights Terminated 9 Parent(s) Deceased 05/20/02 Page 2 of 3 FINDINGS AND DECISION OF THE COURT GRANTING PETITION FOR ADOPTION American LegalNet, Inc. www.FormsWorkflow.com FAMILY COURT ______CIRCUIT STATE OF HAWAI‘I FINDINGS AND DECISION OF THE COURT GRANTING PETITION FOR ADOPTION FC-A No. IT IS THE 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 that 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; 9 (For Stepparent Adoption): The full reciprocal legal rights and duties existing between the child(ren) and the legal parent who is now the spouse 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 05/20/02 JUDGE’S SIGNATURE PAGE 3 OF 3 FINDINGS AND DECISION OF THE COURT GRANTING PETITION FOR ADOPTION American LegalNet, Inc. www.FormsWorkflow.com