COMPLAINT (ASSUMPSIT, SUMMARY POSSESSION/ LANDLORD-TENANT, DAMAGES); DECLARATION; EXHIBIT(S); SUMMONS TWO-SIDED FORM Form #3DC08 IN THE DISTRICT COURT OF THE THIRD CIRCUIT ______________________________ DIVISION STATE OF HAWAI‘I Plaintiff(s) Reserved for Court Use Civil No. Defendant(s) Plaintiff(s)/Plaintiff(s)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers) Street Address, City, State ("the property"): COMPLAINT 1. 2. 3. 4. 5. This Court has jurisdiction over this matter and venue is proper. Plaintiff(s) is the landlord or the agent for the landlord of the property. The property is located in this division of this Court. Defendant(s) rents and/or is in possession of the property and/or is a personal guarantor under the rental agreement of the property. G There is a written rental agreement for the property. A copy of the written rental agreement for the property (and any amendments to the rental agreement) is attached as Exhibit 1. G There is no written rental agreement for the property, only an oral agreement. G There is an expired written rental agreement for the property. An accurate copy of the written rental agreement is attached as Exhibit 1. Defendant(s) are month-to-month tenant(s). 6. Defendant(s) has broken the rental agreement because: G Unpaid rent $ . G Other: . 7. Written notice was given to Defendant(s) on , 20 to correct this situation. An accurate copy of the written notice is attached as Exhibit 2. 8. Despite the notice, Defendant(s) has failed to correct this situation and still is in possession of the property. (continued on reverse side) COMPASP.2X (Amended 4/18/97)v SEE REVERSE SIDE 3D-P-261 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 COMPLAINT (continued) 9. As of , 20 Plaintiff(s) $ , Defendant(s) owed for: G Rent itemized as follows: G Other: Plaintiff(s) is asking the Court for the following: A. A judgment giving Plaintiff(s) possession of the property. B. A Writ of Possession directing the Sheriff or Police Officer to: 1. Remove Defendant(s) from the property and all persons possessing the property through Defendant(s); 2. Remove from the property all personal belongings of Defendant(s) and of any other person; and 3. Put Plaintiff(s) in possession of the property. C. Judgment against Defendant(s) for $ . In addition, the Court may award any rent and other charges owed under the rental agreement, additional damages, court costs, interest, and reasonable attorney's fees. Signature of Plaintiff(s)/Plaintiff(s)' Attorney: Date: Print/Type Name: DECLARATION I have read this Complaint, 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 ABOVE IS TRUE AND CORRECT. Signature of Declarant: Date: Print/Type Name: 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-261 American LegalNet, Inc. www.FormsWorkflow.com