Free Complaint (Personal Injury) - Hawaii


File Size: 462.2 kB
Pages: 2
Date: August 22, 2008
File Format: PDF
State: Hawaii
Category: Court Forms - State
Author: Unknown
Word Count: 545 Words, 3,212 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.state.hi.us/jud/Kauai/District/5DC09.pdf

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Complaint (personal injury/ propety Damage); summons in the DistriCt Court of the fifth CirCuit state of hawai`i
Plaintiff(s)

Form #5DC09

Reserved for Court Use

Civil No. Defendant(s) Plaintiff(s)/Plaintiff(s)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers)

Date of Injury / Damage: COMPLAINT l. This Court has jurisdiction over this matter and venue is proper. 2. On or about the date of injury/damage stated above, Defendant(s) intentionally and/or negligently injured Plaintiff(s) and/or damaged Plaintiff(s) property by: (state location of incident and briefly explain what happened)

3. As a result of the incident, Defendant(s) caused the following damages: Physical Injury (Do not state the dollar amount, but give brief description of damage):

Property damage in the amount of amount of $

. (Explain the type of damage):

4. Defendant(s) has refused to pay for Plaintiff(s) damages. 5. Plaintiff(s) asks for judgment against Defendant(s) for the damages proved. In addition, the Court may award court costs, interest and reasonable attorney's fees. Signature of Plaintiff(s)/Plaintiff(s)' Attorney: Date:
Comppi

Print/Type Name(s):
I certify that this is a full, true, and correct copy of the original on file in this office.

Clerk, District Court of the above Circuit, State of Hawai`i
Reprographics (12/07) 5D-P-175

Clear form

SummonS In The DISTrIcT courT of The fIfTh cIrcuIT STaTe of hawaI`I
Plaintiff(s)

Form #5DC50

Reserved for Court Use

Civil No. Defendant(s) Plaintiff(s)/Plaintiff(s)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers)

SUMMONS THE STATE OF HAWAI`I: TO: The Director of Public Safety of the State of Hawai`i, his/her deputy or any police officer or other person authorized by the laws of the State of Hawai`i: You are commanded to summon the Defendant(s) to appear before the District Judge of this Court in his/her Courtroom, to appear at the Court designed below. The Summons shall not be personally delivered between 10:00 p.m. and 6:00 a.m. on premises not open to the public, unless a Judge of the above-entitled Court permits, in writing on this Summons, personal delivery during those hours. TO THE DEFENDANT(S): You are required to appear before the District Judge of this Court, in his/her Courtroom, on the day and at the time designated below. If the Defendant(s) is a corporation, Hawai`i law requires it to be represented by an attorney licensed to practice in the State of Hawai`i. District Court, Courtroom #2 at 3970 Ka`ana Street, Li hue, Hawai`i at 8:45 a.m. on Monday and should said Monday be a legal holiday, then upon the next secular Monday. Mailing address for the District Court Division is 3970 Ka`ana Street, Suite 207, Li hue, Hawai`i 96766

Date:

Clerk of the above-entitled Court

Clear Form

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. 482-2347, FAX 482-2509, OR TTY 482-2533 at least (10) working days in advance of your hearing or appointment date.
Reprographics (08/08) SUMMONS 5D-P-230