EX PARTE MOTION FOR DEFAULT JUDGMENT; DECLARATION; EXHIBIT(S) 1 THROUGH _____; DECLARATION OF COUNSEL RE: ATTORNEY'S FEES; ORDER Form 3DC17 IN THE DISTRICT COURT OF THE THIRD CIRCUIT ______________________________ DIVISION STATE OF HAWAI`I Plaintiff Reserved for Court Use Civil No. Defendant Filing Party/Attorney Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Fax Number or Email Against Defendant: Name(s) EX PARTE MOTION FOR DEFAULT JUDGMENT Plaintiff moves for an Order Granting Default Judgment against Defendant on the grounds that Defendant has failed to answer, appear or otherwise defend, and the time to otherwise move or plead has expired and has not been extended in this action. This Motion is made pursuant to District Court Rules of Civil Procedure, Rule 55(b)(2), and is based upon the attached Declaration, Exhibits 1 through _______, and the records and files herein. Signature of Filing Party/Attorney: Date: Print/Type Name: DECLARATION I have read this Motion, know the contents and verify that the statements are true to my personal knowledge and belief. I DECLARE UNDER PENALTY OF PERJURY THAT THE FOLLOWING IS TRUE AND CORRECT: 1. I am G Plaintiff or G associated with Plaintiff as __________________________________________________________ and submit this based upon the personal knowledge and information from the business records maintained in the ordinary course of business and from entries made therein at or near the time of the events so recorded. The following facts show why Defendant owes the unpaid amounts requested by the Plaintiff. (Attach continuation sheet if necessary). 2. 3. 4. 5. Attached as Exhibits 1 through __________ are correct copies of the documents in support of Plaintiff's claims for judgment. Based upon my experience as ______________________________________, the amount claimed by Plaintiff are fair and reasonable. Defendant is not in the military service of the United States as defined by the Servicemembers Civil Relief Act. Signature of Declarant: Date: 3D-P-268 Print/Type Name: CommonLook® 508 Certified Reprographics (09/11) 3D (Rev.08/03/2011) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com SEE REVERSE Form 3DC17 COURT ORDER This Motion is granted. Default Judgment in favor of Plaintiff and against Defendant shall enter as follows: Principal Amount.................................................................. Interest .................................................................................. Attorney's Fees .................................................................... Filing Fee ............................................................................. Service Fee .......................................................................... Mileage for Service.............................................................. Other Costs ......................................................................... Total Default Judgment Amount.......................................... $_________________________ $_________________________ $_________________________ $_________________________ $_________________________ $_________________________ $_________________________ $ 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. (808) 961-7424, FAX (808) 961-7411, or TTY (808) 961-7422 at least ten (10) working days before your proceeding, hearing, or appointment date. For Civil related matters, please call or visit the District Court Civil Section at Hilo Division, 777 Kilauea Avenue, Hilo, Ph. (808) 961-7515 · Kohala Division, 67-5187 Kamamalu St., Kamuela, Ph. (808) 443-2030 · 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 filed in this office. ________________________________________________ Clerk, District Court of the above Circuit, State of Hawai`i 3D-P-268 (Rev.08/03/2011) CommonLook® 508 Certified Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Form 3DC17