Bench Warrant In the DIstrIct court of the fIfth cIrcuIt state of haWaI`I THE STATE OF HAWAI`I vs. Name of ARRESTEE: DOB: SSN (last four digits only): Address of ARRESTEE: Reserved for Court Use Form #5DC03 Civil No. BW No. Filing Party(ies)/Filing Party(ies)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers) Plaintiff(s) Defendant(s) Date Bench Warrant Ordered: bench warrant the State OF hawaI`I: tO: The Director of Public Safety of the State of Hawai`i, his/her deputy or any police officer or other person authorized by the laws of the State of Hawai`i. Because above-named person (ARRESTEE) was duly ordered to appear before this Court at the Original Hearing Date and Time stated above and failed to appear: You are commanded to arrest and bring ARRESTEE before the Presiding District Judge of this Court, in his/her Courtroom, on the day at the time designated by the checked box on the reverse side, then and there to show cause why ARRESTEE should not be found guilty of contempt of court. UnLeSS aUthOrIZeD In wrItInG, thIS warrant MaY nOt be eXecUteD between the hOUrS OF 10:00 P.M. anD 6:00 a.M. On PreMISeS nOt OPen tO the PUbLIc. Date: BAIL SET AT: $ Judge of the above-entitled Court I certify that this is a full, true and correct copy of the original issued in this office. ______________________________________________________ Clerk, District Court of the Above Circuit, State of Hawai`i RepRogRaphics (08/08) American LegalNet, Inc. www.FormsWorkFlow.com benchwaR 5D-p-253 cOUrt aDDreSS Kaua`i Judiciary complex, courtroom #2, 3970 Ka`ana Street, Suite 207, L1 hu`e, hawai`i. Unless authorized in writing this warrant may � � not be executed between the hours of 10:00 P.M. and 7:00 A.M. on premises not open to the public. I am duly authorized by Hawai`i law to serve this Bench Warrant and I executed this Bench Warrant on the following person(s): ___________________________________________________________________________________________________ at __________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ on this _____________ day of ____________________________________________, 20 _________. Signature of Serving Officer: Date: Print/Type Name Badge No.: In accordance with the americans with Disabilities act if you require an accommodation for your disability, please contact the District Court Administration Office at PHONE NO. 482-2347, FAX 482-2509, OR TTY 482-2533 at least (10) working days in advance of your hearing or appointment date. RepRogRaphics (08/08) American LegalNet, Inc. www.FormsWorkFlow.com benchwaR 5D-p-253