Fill and Sign the Hawaii Counterclaim Form

COUNTERCLAIM ; C ERTIFICATE OF SERVICE ; D ECLARATION Form #1DC14 I N THE DISTRICT COURT OF THE FIRST CIRCUIT ______________________________ D IVISION S TATE OF HAWAI ‘I Plaintiff(s) Reserved for Court Use Court Date: REC. # $ Civil No. Defendant(s)/ Defendant(s)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and F acsimile Numbers) Defendant(s) COUNTERCLAIM 1. On or about , Plaintiff(s) owed money to Defendant(s) as follow s: (Attach continuation page, if necessary). 2. Defendant(s) asks for judgment against Plaintiff(s) in the sum of $ . In addition, the Court may award court costs, interest and reaso nable attorney' s fees. CERTIFICATE OF SERVICE I certify that a copy of this Counterclaim was serv ed at the last known address(es) of the Opposing Pa rty(ies) or Opposing Party(ies)' attorney on by G G Hand-delivery o r G G Mail, Postage Prepaid, at the following address(e s): Date: Print/ Type Name: Signature of Defendant(s)/ Defendant(s)' Attorney: DECLARATION I have read this Counterclaim, know the conten ts 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 HAWA I‘I THAT THE ABOVE IS TRUE AND CORRECT. Date: Print/ Type Name: Signature of Declarant: 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. Fo r Civil related matters, please call 538-5151. COUNTCLM. X (Amended 4/ 18/ 97)v 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 o f Hawai‘i