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Statement Of Mailing Exhibits 1 And 2 (Adoption) Form. This is a Hawaii form and can be use in Family Court Statewide.
Tags: Statement Of Mailing Exhibits 1 And 2 (Adoption), Hawaii Statewide, Family Court
STATE OF HAWAI‘I
FAMILY COURT
OF THE ________ CIRCUIT
CASE NUMBER
STATEMENT OF MAILING;
EXHIBITS “1” AND “2”
❑
❑
In the Matter of Adoption of
A ❑ MALE ❑ FEMALE CHILD
Born on:
A ❑ MALE
❑ FEMALE
CHILD
PETITIONER(S) PRO SE
_________________________________________________
❑ FEMALE
CHILD
❑ FEMALE
CHILD
_________________________________________________
Address
Born on:
A ❑ MALE
ATTORNEY FOR PETITIONER(S)
_________________________________________________
Name
Born on:
A ❑ MALE
FC-A NO.
_________________________________________________
City, State, Zip Code
Born on:
_________________________________________________
Telephone Number
by:
❑ the legal spouse of ❑ and
❑ the child(ren)’s legal parent
❑ husband and wife
❑ an unmarried person
Petitioner(s).
I represent that the following documents was served on the person listed below:
❑ Certified copy of the Petition for Adoption (Non-Consent) and attachment
❑ Other:
by certified mail, return receipt requested. At the time of mailing, the receipt attached as Exhibit “1” was received; and in
due course, the return receipt attached hereto as Exhibit “2” was received.
The person served was:
NAME: _______________________________________________________________________________________
ADDRESS: ___________________________________________________________________________________
____________________________________________________________________________________________
CITY, STATE, ZIP CODE: ________________________________________________________________________
DATE
SIGNATURE OF ATTORNEY OR PETITIONER
In accordance with the Americans with Disabilities Act and other applicable state and federal laws, if you require a reasonable accommodation for a disability, please
contact the ADA Coordinator at the First Circuit Court Administration Office at PHONE NO. 539-4333, FAX 539-4322, OR TTY 539-4853 at least ten (10) working
days prior to your hearing or appointment date.
(07/06) Reprographics
PAGE 1 OF 2
STATEMENT OF MAILING; EXHIBITS 1 AND 2 (FC-A) 1F-P-699
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STATE OF HAWAI‘I
FAMILY COURT
OF THE _______ CIRCUIT
CASE NUMBER
STATEMENT OF MAILING;
EXHIBITS “1” AND “2”
FC-A NO.
EXHIBIT 1
EXHIBIT 2
In accordance with the Americans with Disabilities Act and other applicable state and federal laws, if you require a reasonable accommodation for a disability, please
contact the ADA Coordinator at the First Circuit Court Administration Office at PHONE NO. 539-4333, FAX 539-4322, OR TTY 539-4853 at least ten (10) working
days prior to your hearing or appointment date.
(07/06) Reprographics
PAGE 2 OF 2
STATEMENT OF MAILING; EXHIBITS 1 AND 2 (FC-A) 1F-P-699
American LegalNet, Inc.
www.FormsWorkflow.com