Fill and Sign the Garnishee Fee Paid Form

GARNISHEE DISCLOSURE Form #1DC26 I N THE DISTRI CT COURT OF THE FIRST CIRCUIT ______________________________ D IVISION S TATE OF HAWAI ‘I Plaintiff(s) Defendant(s) Reserved for Court Use Court Date: Garnishee Fee paid # $ Garnishee/ Garnishee' s Attorney (Name, Attorney Numb er, Firm Civil No. Name (if applicable), Address, Telephone and Facsim ile Numbers) Judgment Creditor(s)/ Judgment Creditor(s)' Attorney Garnishee' s Name and Address: Judgment Debtor(s): GARNISHEE DISCLOSURE Garnishee above named, and in response to Garnishee Summons served on it, discloses that at the time of service of Garnishee Summons: G 1. Garnishee DID NOT have any goods or effects of Judgment Debtor(s) in its hands, Garnishee was not indebted to Judgment Debtor(s), Garnishee did not have any monies of Jud gment Debtor(s) in its possession for safekeeping, or Judgment Debtor(s) did not owe any wages (including any salary, stipend, c ommissions, annuity or net income or portion of net income under a trust) or was not in receipt of any wages from Garnishee exce pt as follows: G 2. Garnishee DID have goods or effects of Judgment Debtor(s) in its hands, Garnishee was indebted to Judgment Debtor(s ), Garnishee did have monies of Judgment Debtor(s) in its possession for safekeeping, or Judgment Debtor(s) did owe wages or was in receipt of wages (including any salary, stipend, commissions, annuity or net income or portion of n et income under a trust) from Garnishee except as follows: I have read this Disclosure, 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 HAWA I‘I THAT THE ABOVE IS TRUE AND CORRECT. Mail to 1111 Alakea Street, Civil Division, Third Floor, Honolulu, Hawai‘i, 96813. In accordance with the Americans with Disabilities Act if you require an accommodation for your disabilit y, please contact the District Court Administration Office at PHONE NO. 5 38-5121, 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. Date: Print/ Type Name and Title/ Relationship to Garnishee : Signature of Garnishee/ Garnishee' s Attorney: GARNDISC. XX (Amended 4/ 18/ 97)v