Free Request to Inspect Confidential Adoption Records of the Family Court - Hawaii

g:\admin\legalres\adoprec\request08 (rev 2/08)

Form 1 REQUEST TO INSPECT CONFIDENTIAL ADOPTION RECORDS OF THE FAMILY COURT TYPE OR PRINT IN BLACK INK [A copy of your completed request will be included in the notice sent to the adoptee or natural parent.] 1. PRESENT NAME OF APPLICANT: (First, middle and last names). ________________________________________________________________________ ________________________________________________________________________ [ ]male [ ]female 2. 3. RELATIONSHIP TO ADOPTEE (adopted child): (check one box) [ ]adoptee [ ]natural parent [ ]adoptive parent FULL NAME OF ADOPTEE: _____________________________________________ ________________________________________________________________________ (State child's name at birth or after adoption, whichever is known) 4. 5. 6. 7. 8. 9. BIRTHDATE: _______________ PLACE OF BIRTH: _______________________ ADOPTIVE FATHER (if known) ___________________________________________ ADOPTIVE MOTHER (if known) __________________________________________ BIOLOGICAL FATHER (if known) ________________________________________ BIOLOGICAL MOTHER (if known) _______________________________________ REQUEST IS FOR: [ ] Inspection of records [ ] Non-identifying (medical and ethnic background) information on natural parents only. Note: Medical information may not be current [ ] Copy of Adoption Decree [ ] Copy of original birth certificate of child (available to natural parents only) REASONS FOR REQUEST: ______________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

10.

(03/08)1F

1F-P-770

11.

APPLICANT'S ADDRESS: _______________________________________________ ________________________________________________________________________

12. 13.

TELEPHONE NUMBERS: _____________________ (Include area code) (Home)

_____________________ (Work)

APPLICANT DECLARES UNDER PENALTY OF PERJURY THAT THE STATEMENTS MADE HEREIN ARE TRUE AND CORRECT TO THE BEST OF HIS/HER KNOWLEDGE, INFORMATION AND BELIEF. Date: ______________________ Signature: _________________________________

14. 15.

STATE OF __________________________) ) SS. COUNTY OF ________________________) On this date ___________________________________________, before me personally

appeared ___________________________________________________, to me known to be the person named in and who executed the foregoing Request. _______________________________ _______________________________ Notary Public, State of _______________ My commission expires:______________

FOR FAMILY COURT USE ONLY: --------------------------------------------------------------------------------------------------------------------[ ] Picture ID verified Clerk's initials: ___________________

FC-A No. _________________________

(03/08)1F

1F-P-770

CLEAR FORM