AFFIDAVIT ON GARNISHEE TRANSFER; EXHIBIT(S) NOTICE TO EMPLOYER OF JUDGMENT DEBTOR(S); GARNISHEE INFORMATION TWO-SIDED FORM Form #3DC33 IN THE DISTRICT COURT OF THE THIRD CIRCUIT ______________________________ DIVISION STATE OF HAWAI‘I Plaintiff(s) Defendant(s) Reserved for Court Use Civil No. Filing Party(ies)/Filing Party(ies)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile 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) Former Employer: Current Employer: AFFIDAVIT ON GARNISHEE TRANSFER I have read this Affidavit, 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 HAWAI‘I THAT THE FOLLOWING IS TRUE AND CORRECT: 1. I am the Judgment Creditor(s) or Judgment Creditor(s)' attorney; 2. The Judgment (a copy of which is attached as Exhibit A) was entered on the date shown on said Judgment for Judgment Creditor(s) and against Judgment Debtor(s); 3. There is still due and owing the sum of G as shown in the certified copy of the Judgment attached as Exhibit A or G Current Amount Due as evidenced by the attached Exhibit B; (continued on reverse side) GARNTRNS.2X (Amended 4/18/97)v 3D-P-283 SEE REVERSE SIDE 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 of Hawai‘i American LegalNet, Inc. www.FormsWorkflow.com AFFIDAVIT ON GARNISHEE TRANSFER (continued) 4. The Judgment has not been appealed (or if appealed, no bond has been filed), reversed, modified, set aside or satisfied except as aforesaid and otherwise remains in full force and effect; and 5. The Judgment Creditor(s) is still the owner and holder of said Judgment. 6. Judgment Debtor(s) has left the employment of the Former Employer listed and is now believed to be in the employment of the Current Employer listed. 7. A Garnishee Order has been granted against the Former Employer of Judgment Debtor(s) listed. Subscribed and sworn to before me day of this Notary Public, State of Hawai‘i My commission expires: Signature of Affiant: , 20 . Print/Type Name: NOTICE TO EMPLOYER OF JUDGMENT DEBTOR(S) PURSUANT TO HAWAI‘I REVISED STATUTES §652-5, YOU ARE REQUIRED TO WITHHOLD IN AMOUNTS CONSISTENT WITH RATES PROVIDED FOR BY LAW, A PERCENTAGE OF THE JUDGMENT DEBTOR(S)' WAGES (INCLUDING ANY SALARY, STIPEND, COMMISSIONS, ANNUITY OR NET INCOME OR PORTION OF NET INCOME UNDER A TRUST), COMMISSIONS AND COMPENSATION AND PAY THESE FROM WEEK TO WEEK OR MONTH TO MONTH TO THE JUDGMENT CREDITOR UNTIL ALL SUMS DUE UNDER THE JUDGMENT ARE PAID. In accordance with the Americans with Disabilities Act if you require an accommodation for your disability, please contact the ADA Coordinator at PHONE NO. 934-5788, FAX 935-1959, or TTY 961-7525 at least ten (10) working days in advance of your hearing or appointment date. 3D-P-283 American LegalNet, Inc. www.FormsWorkflow.com