COUNTERCLAIM; CERTIFICATE OF SERVICE; DECLARATION Form#3DC14 IN THE DISTRICT COURT OF THE THIRD CIRCUIT DIVISION STATE OF HAWAI221I Reserved for Court Use Plaintiff Civil No. Defendant Defendant/Defendant222s Attorney Name, Attorney Number, Firm Name (if applicable), Address, Telephone number COUNTERCLAIM 1.On or about , Plaintiff owed money to Defendant as follows:(Attach continuation page, if necessary).2.Defendant asks for judgment against Plaintiff in the sum of $ .In addition, the court may award court costs, interest and reasonable attorney222s fees.CERTIFICATE OF SERVICE I certify that a copy of this Counterclaim was served on the Opposing Party or their attorney on (date) by G Hand-delivery or G Mail at the following address: Date: Signature of Defendant/Defendant222s Attorney: Print/Type Name: DECLARATION I have read this Counterclaim, know the contents and verify that the statements are true to my personal knowledge and belief. I DECLARE UNDER PENALTY OF LAW THAT THE ABOVE IS TRUE AND CORRECT. Date: Signature of Declarant: Print/Type Name: 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 at PHONE NO. (808) 961-7629, FAX (808) 961-7577, or email adarequest@courts.hawaii.gov at least ten (10) working days before your proceeding, hearing, or appointment date. For all Civil related matters, please call or visit the District Court Civil Section at Hilo Division, 777 Kilauea Avenue, Hilo, Ph. (808) 961-7515 225 Kohala Division, 67-5187 Kamamalu St., Kamuela, Ph. (808) 443-2030 225 Kona Division, 79-1020 Haukapila St., Kealakekua, Ph. (808) 322-8700. 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 Hawai221i (Rev. 1/23/2018) Form#3DC14 American LegalNet, Inc. www.FormsWorkFlow.com