DECLARATION OF JUDGMENT CREDITOR FOR GARNISHMENT OF WAGES; EXHIBIT(S); NOTICE TO EMPLOYER OF JUDGMENT DEBTOR; GARNISHEE INFORMATION IN THE DISTRICT COURT OF THE FIRST CIRCUIT ______________________________ DIVISION STATE OF HAWAI`I Plaintiff(s) Reserved for Court Use Civil No. Defendant(s) Filing Party/Attorney Name, Attorney Number (if applicable), Address, Telephone and Fax Numbers Garnishee (Name and Address) Certified copy of the Judgment attached as Exhibit A Current Amount Due: $ __________________________________ (If this amount is different from the Judgment Amount, please attach separate sheet showing calculations as Exhibit B) Judgment Debtor(s): Current Place of Employment: DECLARATION 1. I am the Judgment Creditor or Judgment Creditor's attorney; 2. Judgment (a copy of which is attached as Exhibit A) was entered on the date shown on the Judgment for Judgment Creditor and against Judgment Debtor(s); 3. There is still due and owing G the Judgment amount shown in Exhibit A or G the Current Amount Due as evidenced by Exhibit B; 4. The Judgment has not been appealed (or if appealed, no bond has been filed), reversed, modified, set aside or satisfied except as stated above, and otherwise remains in full force and effect; 5. The Judgment Creditor is still the owner and holder of the Judgment; 6. Judgment Debtor is presently believed to be employed at the Current Place of Employment listed above; and 7. The Judgment has been in effect for at least 10 days. I DECLARE UNDER PENALTY OF LAW THAT EVERYTHING IN THIS DECLARATION IS TRUE AND CORRECT. Signature of Declarant: Date: Print/Type Name: SEE PAGE 2 SEE FEDERAL WAGE GARNISHMENT LAW FOR APPLICABLE RESTRICTIONS. (Attached form entitled "Garnishee Information") (Rev. 31 M ay 2006) 1D-P-776 CommonLook® 508 Certified Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com D eclaration of Judgment Creditors - G arnishment of W ages Form#1D C25 Reprographics (1/07) NOTICE TO EMPLOYER OF JUDGMENT DEBTOR The applicable law found in Hawai`i Revised Statues §652-1(b) provides as follows: ". . .the employer shall thereupon either file a disclosure within one week or shall withhold from the wages of the judgment debtor the amounts as [provided by this law] and pay the same to the judgment creditor." Prior to making the final payment, you should contact the Judgment Creditor or the Judgment Creditor's attorney to obtain the final payoff amount, which may include additional interest as allowed by law. If you file a disclosure, send it to: 1111 Alakea Street, Civil Division, Third (3rd) Floor, Honolulu, Hawai`i 96813. For additional information, please refer to Garnishee Information (Form #1DC27) In accordance with state and federal disability laws, if you require an accommodation for a disability when working with a court program, service, or activity, please contact the District Court Administration Office at PHONE NO. 538-5121, FAX 538-5233, or TTY 539-4853 at least ten (10) working days before your proceeding, hearing, or appointment date. For all Civil related matters, please call 538-5151 or visit the District Court Service Center at 1111 Alakea Street, Third (3rd) Floor. (Rev. 31 M ay 2006) 1D-P-776 CommonLook® 508 Certified Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com D eclaration of Judgment Creditors - G arnishment of W ages Form#1D C25