FAMILY COURT _________ CIRCUIT STATE OF HAWAI‘I CASE NUMBER FC-A NO. SUMMONS 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: by [ ]the legal spouse of [ ]and [ ]the child(ren)'s legal parent [ ]husband and wife [ ]an unmarried person Petitioner(s). THE STATE OF HAWAII TO: Name and Address of Non-Consenting Parent/Legal Guardian/Legal Custodian YOU ARE HEREBY NOTIFIED that the attached Petition for Adoption has been filed in the Family Court, First Circuit, State of Hawai‘i. Information regarding the child(ren) to be adopted are as follows: FULL NAME OF CHILD SEX BIRTH DATE [ ] Male [ ] Female [ ] Male [ ] Female [ ] Male [ ] Female [ ] Male [ ] Female 08/07/01 PAGE 1 OF 2 PAGES SUMMONS American LegalNet, Inc. www.FormsWorkflow.com FAMILY COURT _______ CIRCUIT STATE OF HAWAI‘I CASE NUMBER FC-A NO. SUMMONS THE PETITION ALLEGES that your consent to the adoption of the above-named children by the Petitioner(s) above-named is not required and may be dispensed with pursuant to Hawaii Revised Statutes Section 578-2(c) as amended YOU ARE HEREBY SUMMONED to appear at .m. on the first , not a holiday, following ten (10) days after the service of this summons on you in the Family Court located at the Ka‘ahumanu Hale, 777 Punchbowl Street, Second Floor, Honolulu, Hawaii, to answer the Petition for Adoption. IF YOU FAIL to appear at the hearing on date and time and at the place noted above or if you fail to file a written response to the allegations reflected in the Petition for Adoption, further action may be taken including the granting of the adoption without further notice to you. Your written response should be addressed to the Presiding Judge, Family Court, First Circuit, 777 Punchbowl Street, Second Floor, Honolulu, Hawaii 96813 (mailing address: P. O. Box, Honolulu, Hawaii 96811). FAILURE TO OBEY this notice may result in an entry of a default and default judgment against you. YOU ARE FURTHER NOTIFIED that the child, the adoptive parents and the natural parents have rights under H.R.S. Section 578-15 regarding confidentiality of adoption records after the child reaches age 18. DATE CLERK’S SIGNATURE THIS NOTICE SHALL NOT BE PERSONALLY DELIVERED BETWEEN 10:00 P.M. AND 6:00 A.M. ON PREMISES NOT OPEN TO THE PUBLIC, UNLESS A JUDGE OF THIS COURT PERMITS, IN WRITING ON THIS NOTICE, PERSONAL DELIVERY DURING THOSE HOURS. 08/07/01 PAGE 2 OF 2 PAGES SUMMONS American LegalNet, Inc. www.FormsWorkflow.com