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STATE OF HAWAII DEPARTMENT OF PUBLIC SAFETY SHERIFF DIVISION 1111 Alakea Street, Honolulu, Hawaii 96813 Phone No. (808) 538-5605/Fax No. 538-5661

Request No. _______________________

REQUEST FOR SERVICE OF PROCESS AND EXECUTION OF ORDER OF COURT
[A replica of the official Sheriff's form]

Case Plaintiff/Petitioner Defendant/Respondent

Court

State Hawai`i

You are Hereby Instructed to Execute the Accompanying Process as Follows: Document to be Served Name of Person to be Served Address

DEPARTMENT USE ONLY Deputy Assign. Date Status Rpt. Date Court Date Advance pmt: Date Rec. Fee Mileage Other Total

$
Instructions/Notes

NOTICE: All communications, refunds, and/or collections shall be made to the name and address listed below

Name Address

I.D. No. ZIP Code
Date

Contact Person Telephone No.
Signature of Attorney or Litigant