PETITIONER'S MOTION TO SEAL ADDRESS AND TELEPHONE NUMBER IN THE DISTRICT COURT OF THE FIRST CIRCUIT DIVISION STATE OF HAWAI`I Petitioner Form #1DC01 Reserved for Court Use Civil No. Respondent SS Filing Party/Attorney Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Fax Numbers (Petitioner - leave this box blank) PETITIONER'S MOTION TO SEAL ADDRESS AND TELEPHONE NUMBER DECLARATION I DECLARE UNDER PENALTY OF PERJURY THAT THE FOLLOWING IS TRUE AND CORRECT. l. 2. I am the Petitioner. I am requesting that the Court seal my address and/or telephone number because (state facts why you are making the request): Signature of Petitioner: Date: Reserved for Court Use COURT ORDER This motion is: Print/Type Name(s): GRANTED DENIED Date: Judge: In accordance with the Americans with Disabilities Act and other applicable state and federal 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 (10) working days before your proceeding, hearing, or appointment date. For all Civil matters, please call 538-5151 or visit the District Court Service Center at 1111 Alakea Street, Third (3rd) Floor. Reprographics (05/10) CommonLook® 508 Certified American LegalNet, Inc. www.FormsWorkFlow.com 1D-P-764