COUNTERCLAIM; CERTIFICATE OF SERVICE; DECLARATION IN THE DISTRICT COURT OF THE FIRST CIRCUIT ______________________________ DIVISION STATE OF HAWAI`I
Reserved for Court Use
Court Date: $
REC. # Civil No.
Defendant(s)/Defendant(s)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers)
On or about (Attach continuation page, if necessary).
COUNTERCLAIM , Plaintiff(s) owed money to Defendant(s) as follows:
Defendant(s) asks for judgment against Plaintiff(s) in the sum of $ the Court may award court costs, interest and reasonable attorney's fees.
. In addition,
CERTIFICATE OF SERVICE I certify that a copy of this Counterclaim was served at the last known address(es) of the Opposing Party(ies) or Opposing Party(ies)' attorney on by G Hand-delivery or G Mail, Postage Prepaid, at the following address(es):
Signature of Defendant(s)/Defendant(s)' Attorney: Date: Print/Type Name:
DECLARATION I have read this Counterclaim, know the contents and verify that the statements are true to my personal knowledge and belief. I DECLARE UNDER PENALTY OF PREJURY UNDER THE LAWS OF THE STATE OF HAWAI`I THAT THE ABOVE IS TRUE AND CORRECT. Signature of Declarant: Date: Print/Type Name:
In accordance with the Americans with Disabilities Act if you require an accommodation for your disability, please contact the District Court Administration Office at PHONE NO. 538-5121, FAX 538-5233, or TTY 539-4853 at least ten (10) working days in advance of your hearing or appointment date. For Civil related matters, please call 538-5151.
I certify that this is a full, true, and correct copy of the original on file in this office.
COUNTCLM.X (Amended 4/18/97)v
Clerk, District Court of the above Circuit, State of Hawai`i