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Petition for Adoption (Non-Consent)

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FAMILY COURT 
 FIRST CIRCUIT 
  STATE OF HAWAI‘I	
  	
  PETITION FOR ADOPTION 
 (NON-CONSENT) 
 	
  	
CASE NUMBER 
FC-A NO.	
 	
 
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).  
[ ]ATTORNEY FOR PETITIONER(S) 
[ ]PETITIONER(S) PRO SE 
 
                                                                                	
Name	 
                                                                                
 
                                                                                	
Address	 
                                                                               	
City, State, Zip Code	 
                                                                               	
Telephone Number	 
 
 	
ATTACHMENTS: 
[  ]  SUPPORTING AFFIDAVIT 
[  ]                                                                                      
[  ]  ORDER FOR SERVICE BY   
( )MAIL   ( ) PUBLICATION 
( )PERSONAL SERVICE WITHOUT THE STATE 
[  ]  NOTICE OF TIME AND PLACE OF HEARING 
[  ]  SUMMONS	
 	
 
TO THE PRESIDING JUDGE OF THE ABOVE-ENTITLED COURT: 
Comes now Petitioner(s) above-named alleging that: 
JURISDICTION/VENUE	
 (HRS §578-1): 
1.  The Family Court has jurisdiction and venue to grant this petition for adoption because: 
 
[ ]  Petitioner(s) reside(s) or is/are stationed in the military service on the island on which this 
petition is being filed. 
[ ]  The child(ren) being adopted reside(s) or was born on the island on which this petition is 
being filed. 
[ ]  The agency placing the child for adoption is licensed by the Department of Human Services 
and has its principal place of business on the island where this petition is being filed. 	
 
2. Petitioner(s) is/are: 
[ ]  An unmarried person 
[ ]  Married to the legal father or mother of the child(ren) being 
adopted (Stepparent) 
[ ]  Husband and Wife 
[ ]  Other:  Specify relationship:                                                
 
  
 
 
 
 
 
 
 	
  FOR COURT USE ONLY 	
08/07/01     PAGE 1 OR 4 PAGES PETITION FOR ADOPTION (NON-CONSENT)

FAMILY COURT 
 FIRST CIRCUIT 
  STATE OF HAWAI‘I  
  PETITION FOR ADOPTION 
 (NON-CONSENT) 
   	
CASE NUMBER 
FC-A NO.	
 	
 
3. INFORMATION REGARDING THE PETITIONERS: 
 
  
 PETITIONER  
 PETITIONER 
 
Relationship to Adoptee  
  
 
 
Name (First, Middle, Last)  
  
 
 
Birth Name   
  
 
 
Street Address  
  
 
 
City, State, Zip Code  
  
 
 
Home Telephone Number  
  
 
 
Work Telephone Number  
  
 
 
Social Security Number  
  
 
 
Date of Birth  
  
 
 
Place of Birth  
  
 
 
Number of  Prior Marriages	  
[ ]No  [ ]Yes #   	 Prior Marriages  
[ ]No  [ ]Yes #   	 Prior Marriages 	
 
Number of Criminal Convictions  
[ ]No  [ ]Yes #   	 Convictions   
[ ]No  [ ]Yes #   	 Convictions 	 
Contact w/Child Protective Services	  
[ ]No  [ ]Yes  
[ ]No  [ ]Yes 	
 
Present Occupation  
  
 
 
Monthly Gross Income    
  
 
 
Date of Present Marriage  
 
 
Number of Persons Living in Your 
Home	
  
 	
 
4. INFORMATION REGARDING THE CHILD:    †Page 2A attached if more than one child 
 
Date of Birth  
 
 
Place of Birth  
 
 
Sex  
[ ]Male   [ ]Female 
 
Racial Extraction  
 
 
Placed by Agency  
[ ]No  [ ]Yes  Name of Agency:  
 
Living w/Petitioner(s) Since  
 
 
Name after Adoption 
(First, Middle, Last)  
 
08/07/01          PAGE 2 OF 4 PAGES PETITION FOR ADOPTION (NON-CONSENT)

FAMILY COURT 
 FIRST CIRCUIT 
  STATE OF HAWAI‘I  
  PETITION FOR ADOPTION 
 (NON-CONSENT) 
   	
CASE NUMBER 
FC-A NO.	
 	
 
4. INFORMATION REGARDING THE CHILD (continued): 
 
 
Date of Birth  
 
 
Place of Birth  
 
 
Sex  
[ ]Male   [ ]Female 
 
Racial Extraction  
 
 
Placed by Agency  
[ ]No  [ ]Yes  Name of Agency:  
 
Living w/Petitioner(s) Since  
 
 
Name after Adoption 
(First, Middle, Last)  
 
 
INFORMATION REGARDING THE CHILD (continued): 
 
 
Date of Birth  
 
 
Place of Birth  
 
 
Sex  
[ ]Male   [ ]Female 
 
Racial Extraction  
 
 
Placed by Agency  
[ ]No  [ ]Yes  Name of Agency:  
 
Living w/Petitioner(s) Since  
 
 
Name after Adoption 
(First, Middle, Last)  
 
 
INFORMATION REGARDING THE CHILD (continued): 
 
 
Date of Birth  
 
 
Place of Birth  
 
 
Sex  
[ ]Male   [ ]Female 
 
Racial Extraction  
 
 
Placed by Agency  
[ ]No  [ ]Yes  Name of Agency:  
 
Living w/Petitioner(s) Since  
 
 
Name after Adoption 
(First, Middle, Last)

08/07/01          PAGE 2A OF 4 PAGES PETITION FOR ADOPTION (NON-CONSENT)

FAMILY COURT 
 FIRST CIRCUIT 
  STATE OF HAWAI‘I  
  PETITION FOR ADOPTION 
 (NON-CONSENT) 
   	
CASE NUMBER 
FC-A NO.	
 	
 
5.  The Mother of the child(ren):   
[ ]  has signed a Consent to Adoption. 
[ ]  is deceased. 
[ ]  has not consented to the adoption of the child(ren), but her consent is not required or may 
be dispensed with pursuant to the grounds reflected in paragraph 7 below. 
 
6.  In regards to the Father(s) of the child(ren):  
 
The Natural Father of the child(ren): 
[ ]  has signed a Consent to Adoption. 
[ ]  is deceased. 
[ ]  has not consented to the adoption of the child(ren), but his consent is not required or may 
be dispensed with pursuant to the grounds reflected in paragraph 7 below. 
 
The Legal Only Father of the child(ren):  [ ]Not Applicable 
[ ]  has signed a Consent to Adoption. 
[ ]  is deceased. 
[ ]  has not consented to the adoption of the child(ren), but his consent is not required or may 
be dispensed with pursuant to the grounds reflected in paragraph 7 below. 
 
 
7.  Mother's and/or Father's consent to the adoption is not required or may be dispensed with 
because:  
 
[ ]  ( )Father ( )Mother has deserted the child(ren) for a period of at least ninety 90) days.  
HRS §578-2(c)(1)(A) 
[ ]  ( )Father ( )Mother has voluntarily surrendered the care and custody of the child(ren) to 
another for a period of two (2) years. HRS §578-2(c)(1)(B) 
[ ]  ( )Father ( )Mother has failed to communicate with the child(ren) for a period of at least one 
(1) year when able to do so. HRS §578-2(c)(1)(C) 
[ ]  ( )Father ( )Mother has failed to provide for the care and support of the child(ren) for a 
period of at least one (1) year when able to do so. HRS §578-2(c)(1)(D) 
[ ]  The natural father, was not married to the mother of the child(ren), and he is not an 
adjudicated, presumed or concerned father. HRS §578-2(c)(1)(E) 
[ ]  ( )Father ( )Mother had his or her parental rights judicially terminated by a court of 
competent jurisdiction.  HRS §578-2(c)(1)(F) 
[ ]  ( )Father ( )Mother had his or her parental and custodial rights divested by an award of 
permanent custody pursuant to HRS §587-73.  HRS §578-2(c)(1)(K)   
[ ] Other grounds pursuant to HRS §578(c)(1) and/or (2):   
                                                                                                                                              
                                                                                                                                              
                                                                                                                                              
     
 
08/07/01          PAGE 3 OF 4 PAGES PETITION FOR ADOPTION (NON-CONSENT)

FAMILY COURT 
 FIRST CIRCUIT 
  STATE OF HAWAI‘I  
  PETITION FOR ADOPTION 
 (NON-CONSENT) 
   	
CASE NUMBER 
FC-A NO.	
 	
 
8.  The Legal Custodian or Legal Guardian(s) of the child(ren): [ ]Not applicable. 
[ ]  signed a Consent allowing the child(ren) to be adopted. 
[ ]  has not consented to the adoption of the child(ren). 
 
9.  If parental rights have not been terminated or divested previously, due notice of the foregoing 
allegations and of the time and place of hearing of this petition for adoption will be given to the 
non-consenting Parent(s), Legal Custodian or Legal Guardian by: 
[ ]  personal service. 
[ ]  certified or registered mail. 
[ ]  publication. 
 
9.  Adoption of the child(ren) by the Petitioner(s) will be in the best interest of the child(ren). 
 
 
WHEREFORE, it is prayed that: 
(a)  If parental rights have not been terminated or divested previously, notice of the pendency of this 
petition for adoption and of the time and place of hearing be given to the non-consenting Parent(s), 
Legal Custodian or Legal Guardian in the manner indicated in paragraph 9 above. 
(b)  Upon a hearing, the child(ren) be decreed to be the legal child(ren) of the Petitioner(s), effective 
of as of the date of filing of this petition. 
(c)  The name(s) of the child(ren) be decreed as set forth in paragraph numbered 4 above. 
(d)  The Court decree such further relief as will serve the best interest of the child(ren). 
 
Under penalty of perjury, each Petitioner declares that Petitioner has read this Petition for 
Adoption and knows and understands the contents hereof, and that the statements made herein 
are true of Petitioner's own knowledge and belief. 
 
 
DATE  
SIGNATURE OF PETITIONER 
 
 
 
DATE  
SIGNATURE OF PETITIONER 
 
 
08/07/01          PAGE 4 OF 4 PAGES PETITION FOR ADOPTION (NON-CONSENT)
Relevant article from our knowledge database

To ensure everybody is satisfied with the adoption, there's a 3 month adjustment'' period before the adoption is complete. An adoption is not going to be prevented by how a child has a legal guardian. In the state of Texas, adoptions can happen so long as an individual is over age 18 shows evidence of having the ability to provide for the youngster and meet their very best interests. It can be a complex legal matter, and you may need an experienced attorney to handle your petition for adoption. It is a wonderful way to build a family. It can be a tricky process. Personal adoptions are lawful in the majority of states.
Read more

By considering numerous children, you're more likely to attach with a kid. The kid has to have a valid visa. In a stepparent or relative adoption, he or she remains in the custody of the person who asked to adopt the child (if that person is able to take care of the child). Once he or she comes to live with you, you will have a trial period to make sure your family and the child are a good fit.

If your son or daughter is qualified for post-adoption subsidies, you're the youngster's advocate and as such you must understand that the little one receives what's due to him. In case the kid is over twelve years old, the youngster must also consent. He or she may be related to the person adopting the child either by blood or by marriage.

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