GARNISHEE DISCLOSURE IN THE DISTRICT COURT OF THE THIRD CIRCUIT ______________________________ DIVISION STATE OF HAWAI#I Plaintiff(s) Form #3DC26 Defendant(s) Reserved for Court Use Garnishee Fee paid # Court Date: $ Garnishee/Garnishee's Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers) Civil No. Judgment Creditor(s)/Judgment Creditor(s)' Attorney Garnishee's Name and Address: Judgment Debtor(s): GARNISHEE DISCLOSURE Garnishee above named, and in response to Garnishee Summons served on it, discloses that at the time of service of Garnishee Summons: G 1. Garnishee DID NOT have any goods or effects of Judgment Debtor(s) in its hands, Garnishee was not indebted to Judgment Debtor(s), Garnishee did not have any monies of Judgment Debtor(s) in its possession for safekeeping, or Judgment Debtor(s) did not owe any wages (including any salary, stipend, commissions, annuity or net income or portion of net income under a trust) or was not in receipt of any wages from Garnishee except as follows: 2. Garnishee DID have goods or effects of Judgment Debtor(s) in its hands, Garnishee was indebted to Judgment Debtor(s), Garnishee did have monies of Judgment Debtor(s) in its possession for safekeeping, or Judgment Debtor(s) did owe wages or was in receipt of wages (including any salary, stipend, commissions, annuity or net income or portion of net income under a trust) from Garnishee except as follows: G I have read this Disclosure, 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. Mail to: G 777 Kilauea Avenue, Hilo, Hawai#i 96720 G 79-1020 Haukapila Street, Kealakekua, Hawai`i 96750 G 67-5187 Kamamalu Street, Kamuela, Hawai`i 96743. In accordance with the Americans with Disabilities Act if you require an accommodation or assistance, please 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. Signature of Garnishee/Garnishee's Attorney: Date: GARNDISC.XX (Amended 4/18/97)v 3D-P-277 Reprographics (07/09)3D Print/Type Name and Title/Relationship to Garnishee: CommonLook® 508 Certified American LegalNet, Inc. www.FormsWorkFlow.com