COUNTERCLAIM; CERTIFICATE OF SERVICE; DECLARATION Form#5DC14 Reserved for Court Use Plaintiff Civil No. Defendant Defendant/Defendant222s Attorney Name, Attorney Number, Firm Name (if applicable), Address, Telephone number COUNTERCLAIM 1. On or about , Plaintiff owed money to Defendant as follows: (Attach continuation page, if necessary). 2. Defendant asks for judgment against Plaintiff in the sum of $ . In addition, the court may award court costs, interest and reasonable attorney222s fees. CERTIFICATE OF SERVICE I certify that a copy of this Counterclaim was served on the Opposing Party or their attorney on (date) by G Hand-delivery or G Mail at the following address: Date: Signature of Defendant/Defendant222s Attorney: Print/Type Name: DECLARATION I have read this Counterclaim, know the contents and verify that the statements are true to my personal knowledge and belief. I DECLARE UNDER PENALTY OF LAW THAT THE ABOVE IS TRUE AND CORRECT. Date: Signature of Declarant: Print/Type Name: 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. 4822552347, FAX 482-2509, or TTY 482-2533 at least ten (10) working days before your proceeding, hearing, or appointment date. For all Civil related matters, please call 482-2303or visit the Center at 3970 K342221ana Street, L356hu221e, Hawai221i 96766. 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 Hawai221i (Rev. 1/23/2018) Form#5DC14 American LegalNet, Inc. www.FormsWorkFlow.com