Complaint (assumpsit-summary possession/ landlord - tenant, damages); deClaration; exhibit(s); summons in the distriCt Court of the fifth CirCuit state of hawai`i Plaintiff(s) Form #5DC08 Reserved for Court Use Civil No. Defendant(s) Filing Party/Attorney Name, Attorney Number, Firm Name (if applicable), Address, Telephone, Fax Numbers Premises Address: COMPLAINT l. This Court has jurisdiction over this matter and venue is proper. 2. Plaintiff is the landlord or the agent for the landlord of the premises. 3. The premises are located in this division of this Court. 4. Defendant rents and/or is in possession of the premises and/or is a personal guarantor under the rental agreement of the premises. 5. There is a written rental agreement for the premises. A CoPy oF The wRiTTeN ReNTAl AgReemeNT FoR The PRemises (AND ANy AmeNDmeNTs To The ReNTAl AgReemeNT) is ATTACheD. There is no written rental agreement for the premises, only an oral agreement. There is an expired written rental agreement for the premises. A CoPy oF The wRiTTeN ReNTAl AgReemeNT (AND ANy AmeNDmeNTs To The ReNTAl AgReemeNT) is ATTACheD. 6. Defendant(s) has broken the rental agreement because: Unpaid rent $ other 7. written notice was given to Defendant on (date): to correct this situation as follows: 5-day non-payment 10-day non-monetary default 45-day termination of month-to-month tenancy or as specified in the rental agreement or statute(s). A CoPy oF The wRiTTeN NoTiCe IS ATTACHED. 8. Despite the notice, Defendant has failed to correct this situation and still is in possession of the premises. 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 (02/2015) RevaComm 508 Certified Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com COMPASP 5D-P-174 COMPLAINT (continued) 9. The servicemembers Civil Relief Act, 50 U.s.C. App. §501 may apply to a Defendant who is classified active duty as defined in the Act. Please check all that apply. To the best of my knowledge, the Defendant is not an active duty member of the military. The following Defendant is an active duty member of the military. Name: i am unable to determine whether the Defendant is an active duty member of the military. Please attach separate sheet indicating what attempt was made to determine Defendant's military status. 10. As of (date): Defendant(s) owed Plaintiff(s) $ for: . Rent itemized as follows: other: Plaintiff(s) is asking the Court for the following: A. A judgment giving Plaintiff possession of the premises. B. A writ of Possession directing the sheriff or Police officer to: 1. Remove Defendant from the premises and all persons possessing the premises through Defendant: 2. Remove from the premises all personal belongings of Defendant and of any other person; and 3. Put Plaintiff in possession of the premises. C. Judgment against Defendant(s) for $ in addition, the Court may award additional rent and other charges owed under the rental agreement, damages, court costs, interest, and reasonable attorney's fees. signature of Plaintiff/Attorney: Date: Print/Type Name: DECLARATION I DECLARE UNDER PENALTY OF PERJURY THAT WHAT IS STATED IN THE COMPLAINT IS TRUE AND CORRECT. signature of Declarant: Date: Print/Type Name(s): in accordance with the Americans with Disabilities Act, and other applicable state and Federal laws, if you require an accommodation for a disability when working with a court program, service, or activity 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 before your proceeding, hearing, or appointment date. Reprographics (02/2015) RevaComm 508 Certified Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com COMPASP 5D-P-174 SummonS In The DISTrIcT courT of The fIfTh cIrcuIT STaTe of hawaI`I Plaintiff(s) Form #5DC50 Reserved for Court Use Civil No. Defendant(s) Plaintiff(s)/Plaintiff(s)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers) SUMMONS 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: You are commanded to summon the Defendant(s) to appear before the District Judge of this Court in his/her Courtroom, to appear at the Court designed below. The Summons shall not be personally delivered between 10:00 p.m. and 6:00 a.m. on premises not open to the public, unless a Judge of the above-entitled Court permits, in writing on this Summons, personal delivery during those hours. TO THE DEFENDANT(S): You are required to appear before the District Judge of this Court, in his/her Courtroom, on the day and at the time designated below. If the Defendant(s) is a corporation, Hawai`i law requires it to be represented by an attorney licensed to practice in the State of Hawai`i. District Court, Courtroom #2 at 3970 Ka`ana Street, Li hue, Hawai`i at 8:45 a.m. on Monday and should said Monday be a legal holiday, then upon the next secular Monday. Mailing address for the District Court Division is 3970 Ka`ana Street, Suite 207, Li hue, Hawai`i 96766 Date: SUMMONS Clerk of the above-entitled Court 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. (808) 482-2347, FAX (808) 482-2309, or TTY (808) 482-2533 at least ten (10) working days in advance of your hearing or appointment date. Reprographics (12/07) RevaComm 508 Certified American LegalNet, Inc. www.FormsWorkFlow.com 5D-P-230