MOTION FOR ISSUANCE OF GARNISHEE SUMMONS AFTER JUDGMENT; DECLARATION; DECLARATION; ORDER; EXHIBIT(S): GARNISHEE SUMMONS; GARNISHEE INFORMATION; IN THE DISTRICT COURT OF THE THIRD CIRCUIT STATE OF HAWAI`I Form #3DC29 DIVISION Plaintiff(s) Reserved for Court Use Civil No. Defendant(s) Filing Party(ies)/Filing Party(ies)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers) Garnishee(s) (Name and Address) Copy of 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) MOTION FOR ISSUANCE OF GARNISHEE SUMMONS AFTER JUDGMENT TO THE JUDGE OF THE ABOVE-ENTITLED COURT: Judgment Creditor(s) moves that a Garnishee Summons issue according to Law directed to the Garnishee(s) named above for: WAGES (including any salary, stipend, commission, annuity or net income or portion of net income under a trust) payable to and/or earned by Judgment Debtor(s), __________________________________________________________________________________ ___________________________________________________________________________________________________________ . FUNDS/GOODS/EFFECT/COMMISSIONS/COMPENSATION as to Judgment Debtor(s), _____________________________ ___________________________________________________________________________________________________________ . If this is a garnishment for "funds" (other than wages) belonging to a Judgment Debtor(s) who is an individual and a Garnishee who is a financial institution, then the Second Declaration on the page 2 must be completed. Signature of Filing Party(ies)/Filing Party(ies)' Attorney: Date: Print/Type Name: In accordance with the Americans with Disabilities Act, and other applicable State and Federal laws, if you require an accommodation for your disability, when working with a court program, service, or activity please contact the District Court Administration Office at PHONE NO. 961-7424, FAX 961-7411, OR TTY 961-7422 at least (10) working days before your hearing or appointment date. 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 REPROGRAPHICS (07/09) CommonLook® 508 Certified Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com GARNMIGS 3D-P-279 DECLARATION I have read the 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 Judgment Creditor(s) or Judgment Creditor(s)' attorney; 2. The Judgment (a copy of which is attached as Exhibit A) was entered on the date shown on said Judgment for Judgment Creditor(s) and against Judgment Debtor(s) in the sum of the Judgment Amount Due stated; 3. There is still due and owing; the amount shown in the copy of the Judgment attached as Exhibit A or the amount shown in the attached 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 aforesaid and otherwise remains in full force and effect, and 5. The Judgment Creditor(s) is still the owner and holder of said Judgment; 6. I am informed and believe that Garnishee(s) is indebted to Judgment Debtor(s) or is holding moneys or goods or effects of Judgment Debtor(s) for safekeeping, or is paying to Judgment Debtor(s) salaries, stipends, commissions, wages, annuities or net income or portions of net income under a trust. Signature of Declarant: Date: Print/Type Name: DECLARATION 1. Based on the following information, the funds sought to be garnished are not traceable to funds that would be exempt from garnishment under the provisions of Federal and State laws as the judgment debtor does not receive: a. b. c. d. e. Temporary Assistance for Needy Families (TANF) benefits or funds; unemployment benefits (Hawai`i Revised Statutes §383-163); social security payments worker's compensation benefits (Hawai`i Revised Statutes §386-57); or pension or retirement program payment exempt from garnishment under Hawai`i Revised Statutes §653-3 or 651-124. 2. I know the information in the above paragraph is true and correct based upon; an examination of the Judgment Debtor or Person having knowledge conducted on the Judgment Debtor's answer to interrogations the Judgment Debtor's deposition answers the Judgment Debtor's production of documents, or my personal knowledge of the Judgment Debtor (state the specific basis for your personal knowledge): (attach continuation page, if necessary). I have read this Declaration, know the contents and verify that the statements are true to my personal knowledge and belief. I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of Filing Party(ies)/Filing Party(ies)' Attorney: Date: Print/Type Name: ORDER Filing Party is Ordered to provide a blank Garnishee Disclosure to all Garnishees named above. This motion is granted and IT IS ORDERED that Garnishee Summons issue according to law. Date: REPROGRAPHICS (07/09) Judge of the above-entitled Court CommonLook® 508 Certified Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com GARNMIGS 3D-P-279