DECLARATION OF JUDGMENT CREDITOR FOR GARNISHMENT OF WAGES; EXHIBIT(S); NOTICE TO EMPLOYER OF JUDGMENT DEBTOR; GARNISHEE INFORMATION IN THE DISTRICT COURT OF THE THIRD CIRCUIT ______________________________ DIVISION STATE OF HAWAI`I Plaintiff(s) Form# 3DC25 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 FEDERAL WAGE GARNISHMENT LAW FOR APPLICABLE RESTRICTIONS. (Attached form entitled "Garnishee Information") SEE PAGE 2 GARNAFFJ CommonLook® Reprographics (07/09)3D 508 Certified Page 1 of 2 Declaration of Judgment Creditors - Garnishment of Wages 3D-P-276 American LegalNet, Inc. www.FormsWorkFlow.com 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, that may include additional interest as allowed by law. If you file a disclosure, send it to: [ ] 777 Kilauea Avenue, Hilo, HI 96720 [ ] 79-1020 Haukapila Street, Kealakekua, HI 96750 [ ] 67-5187 Kamamalu Street, Kamuela, HI 96743 In accordance with the Americans with Disabilities Act if you require an accommodation or assistance, contact the ADA Coordinator at PHONE NO. 961-7424, FAX 961-7411, or TTY 961-7422 at least ten (10) working days in advance of your hearing, or appointment date. For all Civil related matters, please call or visit the District Court at: Hilo Division, 777 Kilauea Avenue, Hilo, Ph. 961-7515 - Kohala Division, 67-5187 Kamamalu Street, Kamuela, Ph. 443-2030 - Kona Division, 79-1020 Haukapila Street, Kealakekua, Ph. 322-8700 GARNAFFJ CommonLook® Reprographics (07/09)3D 508 Certified Page 2 of 2 Declaration of Judgment Creditors - Garnishment of Wages 3D-P-276 American LegalNet, Inc. www.FormsWorkFlow.com