Free 1F-P-699StateMailFC-A - Hawaii

STATE OF HAWAI`I FAMILY COURT OF THE FIRST CIRCUIT In the Matter of Adoption of A MALE FEMALE CHILD Born on: A MALE Born on: A MALE Born on: A MALE Born on: by:

CASE NUMBER

STATEMENT OF MAILING; EXHIBITS "1" AND "2"

FC-A NO.

ATTORNEY FOR PETITIONER(S) PETITIONER(S) PRO SE

FEMALE FEMALE FEMALE

CHILD

_________________________________________________ Name _________________________________________________

CHILD

_________________________________________________ Address _________________________________________________ City, State, Zip Code _________________________________________________ Telephone Number

CHILD

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

STATE OF HAWAI`I FAMILY COURT OF THE FIRST 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