Free Counterclaim - Hawaii

CounterClaim; CertifiCate of ServiCe; DeClaration
in the DiStriCt Court of the fifth CirCuit State of hawai`i
Plaintiff(s)

Form #5DC14

Reserved for Court Use

Court Date:

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

CounterClAim 1. On or about ____________________________________________, Plaintiff(s) owed money to Defendant(s) as follows: 2. Defendant(s) asks for judgment against Plaintiff(s) in the sum of $ ______________________________________. In addition, the Court may award court costs, interest and reasonable attorney's fees. CertifiCAte of ServiCe 1. 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 Hand-delivery or 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 perjury 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. 482-2347, FAX 482-2509, OR TTY 482-2533 at least (10) working days in advance of your hearing or appointment date. 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 (05/08) countcLM 5d-p-180

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