RETURN OF SERVICE; ACKNOWLEDGMENT OF SERVICE IN THE DISTRICT COURT OF THE THIRD CIRCUIT ______________________________ DIVISION STATE OF HAWAI`I Plaintiff(s) Form #3DC47 Reserved for Court Use Court Date: Civil No. Requestor(s)/Requestor(s)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers) Defendant(s) DOCUMENT(S) SERVED: NAME OF PARTY SERVED: ADDRESS WHERE SERVED: DATE SERVED: TIME OF SERVICE: MILEAGE: $ NUMBER OF MILES TRAVELED: G FULL OR G PARTIAL RETURN OF SERVICE I have read this Return of Service, 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 FOLLOWING IS TRUE AND CORRECT: I, G Deputy Sheriff, or G Police Officer of the State of Hawai`i, or G person who is not a party and is not less than 18 years of age, do certify that I received a certified copy of the documents listed above and that I served same on the Party Served above on the Date and Time of Service and at the Address listed above within the State of Hawai`i as listed on the reverse: (continued on reverse side) Signature: Print/Type Name: ROS.2XX (Amended 4/18/97)v 3D-P-297 Reprographics (10/09)3D Print/Type Address, Telephone and Facsimile Numbers: 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 American LegalNet, Inc. www.FormsWorkFlow.com G FULL OR G PERSONAL: By delivering to and leaving with G PARTIAL RETURN OF SERVICE (continued) , personally. G SUBSTITUTE: [District Court Rules of Civil Procedure 4(d)(1)(i)] After due and diligent search and inquiry, I served the named party through , a person of suitable age and discretion then residing at said party's usual place of abode, since the party could not be found. G SUBSTITUTE: [District Court Rules of Civil Procedure 4(d)(1)(ii)] I served the named party through authorized agent to receive service of process for said party. , G BUSINESS/CORPORATION/GOVERNMENTAL ENTITY: I served (name of business/corporation/entity) through and who is the authorized agent to accept service for said Business/Corporation/Governmental Entity. , who is the (position/title) G GARNISHMENT: I served (Name of Garnishee) through and who is authorized to accept service for the above-named garnishee. , who is the (position/title) G NOT FOUND: After due and diligent search and inquiry, I am unable to find the party named above. G Special Circumstances: ACKNOWLEDGMENT OF SERVICE Signature of Person served: Print/Type Name: 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. RETURN OF SERVICE MUST BE FILED NO LATER THAN 24 HOURS (EXCLUDING SATURDAY, SUNDAY AND LEGAL HOLIDAYS) PRIOR TO THE RETURN DATE AT G 777 KILAUEA AVENUE, HILO, HAWAI 96720 G 79-1020 HAUKAPILA STREET, KEALAKEKUA, HAWAI#I 96750 # #I # G 67-5187 KAMAMALU STREET, KAMUELA, HAWAI#I 96743 # 3D-P-297 Reprographics (10/09)3D American LegalNet, Inc. www.FormsWorkFlow.com CommonLook� 508 Certified