COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . .STATE .OF .HAWAI‘I . . ..... .. ....... DISTRICT COURT : TWO-SIDED FORM Form#5DC05 Index No. CIVIL INFORMATION SHEET : Calendar No. Read reverse before completing this form (1) Plaintiff(s) Plaintiff(s) RESERVED FOR COURT USE: : CIVIL NO. -against- JUDICIAL SUBPOENA : FILED ON: REC#: : $ : COURT DATE: Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(2) Plaintiff(s)/Plaintiff(s)’ Attorney (Name, Attorney Number, ...... Firm Name (if applicable), Address, Telephone and Facsimile Numbers (1) Defendant(s) THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , at the (3) Filing Division Court located at County of ❑ No Exhibit(s) attached to Complaint: the Yes day of in room , on ❑ , 20 , at noon, and at any recessed ❑ o'clock (L)the Lı hu‘e in - loa (KO) or adjourned date, to testify and give evidence as a witness in this action on the part of the ❑ Ko (5) Principal Honorable the Amount Claimed by Plaintiff(s) $ Address of “the property” for Summary Possession cases: ❑ Waimea (W) ❑ Kawaihau (KA) ____________________________________________________ ❑ Hanalei (H) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to ____________________________________________________ for a maximum penalty of $50 and all damages sustained as a the party on whose behalf this subpoena was issued result of your failure to comply. (6) Foreign Judgment: State of ____________________________ Witness, Honorable Court in County, day of Date of Judgment: ______________________________________ Judgment Amount: _____________________________________ Balance of Judgment: ___________________________________ Judgment Debtor(s)’ Address: ____________________________ ____________________________________________________ (4) Nature of Suit , one of the Justices of the , 20 ❑ (61) Regular Claims ❑ (601) Assumpsit (Money Owed) ❑ (701) Property Damages (Attorney must sign above and type name below) ❑ (701) Personal Injury Damages ❑ (801) Summary Possession (Landlord/Tenant) ❑ (901) Replevin (Return of Property or Its Value) Attorney(s) for ❑ (999) Other Civil Action — Specify: __________________________________________ ____________________________________________________ Office and P.O. Address (7) Date and Signature of Plaintiff(s)/Plaintiff(s)’ Attorney: Print/Type Name: CIVLINF.1.2XX (Amended 4/18/97) 5D-E-167 (04/03) ❑ (63) Special Proceedings ❑ (101) Restraining Order ❑ (201) Foreign Judgment Telephone No.: Facsimile No.: Appeal of Finance Director’s Decision ❑ (301) E-Mail Address: ❑ (999) Other — Specify: __________________________________________ Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. HAWAI‘I SUPREME COURT RULES : INSTRUCTIONS FOR COMPLETING THE Calendar No. DISTRICT COURT CIVIL INFORMATION SHEET : JUDICIAL SUBPOENA Plaintiff(s) This form is required by the Court to initiate the civil docket sheet. Consequently, this form must be attached -against: to the original Complaint and original amended Complaint(s), however, this form does not replace nor supplement those pleadings. : The Plaintiff(s)/Plaintiff(s)’ attorney filing a civil Complaint is to complete this form. : Do not leave any areas blank. If information does not apply indicate “not applicable”. Defendant(s) : (1) PLAINTIFF(S).-. DEFENDANT(S) . . . . . . . . . . . . . . . . . . . . . . . . . ............ ............... • If you are the party(ies) filing the claim, you are the Plaintiff(s). • The party(ies) being sued is the Defendant(s). • List names the same way as in the Complaint. • THE PEOPLEor Defendant(s) is a government agency, use only the full name. If Plaintiff(s) OF THE STATE OF NEW YORK • If Plaintiff(s) or Defendant(s) is an official within a government agency, first identify the agency and then the TO official’s name and title. • If additional space is necessary to list all attorney(s), a separate page may be attached noting in this section, “(see attachment)”. GREETINGS: (2) PLAINTIFF(S) PRO SE/PLAINTIFF(S)’ ATTORNEY • List Plaintiff(s)/Plaintiff(s)’ attorney’s name, license number, address, firm name (if applicable), telephone and WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before facsimile numbers. , the Honorable at the Court • If additional space is necessary to list all attorney(s), a separate page may be attached noting in this section, located at County of “(see attachment)”. in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the (3) FILING DIVISION • Place an “X” in the appropriate box. (4) NATURE Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to OF SUIT • the party “X” in the behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Place an on whose appropriate box. • result of your failure than one nature of suit, select the most definitive. If the case fits more to comply. • Summary Possession (Landlord/Tenant) includes back rent, holdover rent and additions to rent. Witness, Honorable , one of the Justices of the (5) PRINCIPAL AMOUNT CLAIMEDday of BY PLAINTIFF(S) Court in County, , 20 • Complete this section using the principal amount you are asking for relief from the Court. • The amount claimed in the Complaint shall control if it is different from this amount. • Any Exhibits attached to your Complaint must be labeled in numerical order beginning with Exhibit 1. (Attorney must • If the Nature of Suit checked is Summary Possession, provide the address ofsign above and type name below) the property. (6) FOREIGN JUDGMENTS • Complete this section if the Nature of Suit checked is Regular Claims, Foreign Judgment. Attorney(s) for • Include the name of the State where the judgment was obtained. • Provide the total amount of your judgment and the balance now due and owing. • List the complete address of the last known address of Judgment Debtor(s). • If additional space is necessary to list all Judgment Debtor(s), a Office and P.O. Address separate page may be attached noting in this section, “(see attachment)”. (7) SIGNATURE OF PLAINTIFF(S)/PLAINTIFF(S)’ ATTORNEY OF RECORD Telephone No.: • The Plaintiff(s)/Plaintiff(s)’ attorney should date and sign this section. Facsimile No.: E-Mail accommodation or assistance, please contact the In accordance with the Americans with Disabilities Act if you require anAddress: Mobile Tel. or TTY 539-4853 at least ten (10) working District Court Administration Office at PHONE NO. 246-3347, FAX 246-3353,No.: days in advance of your hearing or appointment date. American LegalNet, Inc. www.USCourtForms.com 5D-E-167