Free Complaint (Assumpsit) - Hawaii

COMPLAINT (ASSUMPSIT-MONEY OWED); DECLARATION; EXHIBIT(S); SUMMONS IN THE DISTRICT COURT OF THE THIRD CIRCUIT ______________________________ DIVISION STATE OF HAWAI`I
Plaintiff(s)

Form #3DC07

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)

Amount Claimed by Plaintiff:

Last Date of Indebtedness:

1. 2.

COMPLAINT This Court has jurisdiction over this matter and venue is proper. On or about , Defendant(s) owed money to Plaintiff(s) as follows:

3. 4.

G A copy of the written instrument on which the debt is based is attached as Exhibit 1.
Plaintiff(s) asks for judgment in the principal amount of $ In addition, the Court may award court costs, interest and reasonable attorney's fees. Signature of Plaintiff(s)/Plaintiff(s)' Attorney: .

Date:

Print/Type Name:

DECLARATION I have read this Complaint, 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 ADA Coordinator at PHONE NO. 934-5788, FAX 935-1959, or TTY 961-7525 at least ten (10) working days in advance of your hearing or appointment date.
COMPA.X (Amended 4/18/97)v
3D-P-260

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 (11/06)

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