CertifiCate of ServiCe in the DiStriCt Court of the fifth CirCuit State of hawai`i Plaintiff(s) Form #5DC04 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) Name of Document Being Served and Filing Date: CERTIFICATE OF SERVICE I certify that a copy of the above described document was served at the last known address(es) of the Opposing Party(ies) or Opposing Party(ies)' attorney on ________________________ by Hand-delivery or Mail. Postage Prepaid, at the following address(es): Signature of Filing Pary(ies)/Filing Party(ies)' Attorney: Date: Print/Type Name: 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 (05/08) ceRTos 5D-p-172 American LegalNet, Inc. www.FormsWorkFlow.com