FAMILY COURT FIRST CIRCUIT STATE OF HAWAI`I
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
NOTICE TO DHS OF PENDENCY OF ACTION
CASE NUMBER FC-A NO.
[ ]ATTORNEY FOR PETITIONER(S) [ ]PETITIONER(S) PRO SE
Address City, State, Zip Code Telephone Number
Petitioner(s). TO: DIRECTOR OF HUMAN SERVICES c/o Child Welfare Services Intake Unit Attn: Ms. Johnny A. Papa, Supervisor 420 Waiakamilo Road, Suite 300A Honolulu, Hawaii 96817 Pursuant to Section 578-8(b), Hawaii Revised Statutes, you are hereby notified that an adoption petition for the above entitled matter has been filed and is pending before the Court. You have twenty-one (21) days from the receipt of this Notice to make such investigation and to file a written report as you may deem proper as to the fitness of the petitioner(s) to adopt the individual(s). Extensions of time may be granted for good cause shown. Please direct all reports and requests for extensions to Family Court, Attention: Adoption Clerk.
Clerk of the Court's Signature
FOR COURT USE ONLY 08/07/01 NOTICE TO DHS OF PENDENCY OF ACTION