DECLARATION REGARDING ATTORNEYS222 FEES AND COSTS; EXHIBITS Form# 5DC02 #Reserved for Court Use Plaintiff Civil No. Defendant Filing Party/Attorney Name, Attorney Number, Firm Name (if applicable), Address and Telephone Number DECLARATION REGARDING ATTORNEYS222 FEES AND COSTS I am the attorney for the prevailing party, and I request an award of attorneys222 fees pursuant to Hawai#i Revised Statutes [check all that apply]: G 247 607-14 (assumpsit); G 247 521-35 (residential rental agreement); G Commercial lease agreement; G 247 514B-157 (condominium association); G 247 421J-10 (planned community association) G Other statute 247. The amount of the judgment (principal and interest) is anticipated to be $. I. ATTORNEYS222 FEES (Select A or B)* *PLEASE NOTE: In addition to completing section A or B below, you must attach as Exhibit 1 an itemized report of the time spent on the action and to be spent to obtain a final written judgment, the hourly rates, a brief description of the work performed, and the total fees requested. G A. Fee Based on an Hourly Rate. I have expended and am likely to expend to obtain a final judgment the following hours at the rate specified below. Hours: x Hourly Rate: $ Total Fees = $ G B. Fee Based on an Agreed-Upon Fee (Explain the fee agreement below). The attorneys222 fee incurred in this action are not based on an hourly rate. The agreed-upon fee is $. TOTAL FEES REQUESTED: $ SEE PAGE 2 (Rev. 1/23/2018) Page 1 of 2 Form# 5DC02 American LegalNet, Inc. www.FormsWorkFlow.com DECLARATION REGARDING ATTORNEYS222 FEES AND COSTS (continued) II. OTHER COSTS I request an award of costs for actual disbursements itemized below pursuant to District Court Rules of Civil Procedure Rule 54(d) and Hawai#i Revised Statutes [check all that apply]: G 247607-9; G Other [specify statute]: 247. I have attached as Exhibit 2 true copies of invoices and/or receipts for the requested costs. *PLEASE NOTE: Do not include filing fees, service costs or mileage in your request for other costs. Those costs should be reflected on the Judgment form but do not require additional court approval. Item Am ount Requested TOTAL OTHER COSTS REQUESTED: $ I DECLARE UNDER PENALTY OF LAW THAT THE FOREGOING IS TRUE AND CORRECT. Date: Signature of Declarant: Print/Type Name: For Court Use Only: ORDER Approved and so Ordered: Attorneys222 Fees: $ ; Other Costs: $ Judge 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 ten (10) working days before your proceeding, hearing, or appointment date. For Civil-related matters, please call 482-2303 or visit the S Center at 3970 K342221ana , L356hu221e, Hawai221i 96766. (Rev. 1/23/2018) Page 2 of 2 Form# 5DC02 American LegalNet, Inc. www.FormsWorkFlow.com