Name Address Tel. No. Attorney for IN THE CIRCUIT COURT OF THE ____________ CIRCUIT STATE OF HAWAI`I ) ) ) ) ) Plaintiff(s), ) ) vs. ) ) ) ) ) ) Defendant(s). ) _______________________________________) CIVIL NO. ________________________ ARB. NO. _________________________ REQUEST TO REMOVE A CASE FROM THE COURT ANNEXED ARBITRATION PROGRAM; SUMMARY OF FACTS REQUEST TO REMOVE A CASE FROM THE COURT ANNEXED ARBITRATION PROGRAM _____________________________________________________________________________ , Attorney for requests that this case be removed from the Court Annexed Arbitration Program, as the probable jury award value, not reduced by the issue of liability, exclusive of attorney's fees, interest and cost, is in excess of $150,000.00. This request is made pursuant to Rule 8 (C), Hawai`i Arbitration Rules, as amended, and the Summary of Facts attached hereto. DATED: , Hawai`i, ____________________________________. __________________________________________ CAAP 28.DOC 1C-P-522 (08/05) RevaComm 508 Certified American LegalNet, Inc. www.FormsWorkFlow.com , Attorney for