RetuRn of SeRvice; Acknowledgment of SeRvice in the diStRict couRt of the fifth ciRcuit StAte of hAwAi`i Plaintiff(s) Form #5DC47 Reserved for Court Use Court Date: Civil No. Defendant(s) Requestor(s)/Requestor(s)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Number(s) DOCUMENT(S) SERVED: ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ NAME OF PARTY SERVED: ADDRESS WHERE SERVED: DATE SERVED: TIME OF SERVICE MILEAGE $ NUMBER OF MILES TRAVELED: FULL OR PARTIAL RETURN OF SERVICE I have read this Return of Service, know the contents and verify that the statements are true to my personal knowledge and belief. I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF HAWAI`I THAT THE FOLLOWING IS TRUE AND CORRECT: 1. Civil Deputy or Deputy Sheriff or Police Officer of the State of Hawai`i or person who is not a party and is not less than 18 years of age, do certify that I received a certified copy of the documents listed above and that I served same on the Party Served above on the Date and Time of Service and at the Address listed above within the State of Hawai`i as listed on the reverse. Signature: Print/Type Name RepRogRaphics (08/08) Print/Type Address, Telephone and Facsimile Numbers American LegalNet, Inc. www.FormsWorkFlow.com Ros 5d-p-267  FULL OR PARTIAL RETURN OF SERVICE (continued) PERSONAL: By delivering to and leaving with ______________________________________________________, personally. SUBSTITUTE: [District Court Rules of Civil Procedure 4(d)(1)(i)]. After due and diligent search and inquiry, I served the named party through ______________________________________________________________________________________ _______________________________________________________________________________________________________ , a person of suitable age and discretion then residing at said party's usual place of abode, since the party could not be found. SUBSTITUTE: [District Court Rules of Civil Procedure 4(d)(1)(ii)]. I served the named party through ____________________ , _______________________________________________________ authorized agent to receive service of process for said party. BUSINESS/CORPORATION/GOVERNMENTAL ENTITY: I served (name of business/corporation/entity) _____________ _______________________________________________________________________________________________________ through ___________________________________________________________________________ , who is the (position/title) _______________________________________________________________________________________________________ and who is the authorized agent to accept service for said Business/Corporation/Governmental Entity. GARNISHMENT: I served (Name of Garnishee) ______________________________________________________________ _______________________________________________________________________________________________________ through ____________________________________________________________________________ , who is the (person/title) _______________________________________________________________________________________________________ and who is authorized to accept service for the above-named garnishee. NOT FOUND: After due and diligent search and inquiry, I am unable to find the party named above. Special Circumstance: ACKNOWLEDGMENT OF SERVICE Signature of Person served: 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. RETURN OF SERVICE MUST BE FILED NO LATER THAN 24 HOURS (EXCLUDING SATURDAY, SUNDAY ¯ AND LEGAL HOLIDAYS) PRIOR TO THE RETURN DATE AT 3970 KA`ANA STREET, DC CIVIL SECTION, LIHU`E, HAWAI`I 96766-1367. RepRogRaphics (08/08) American LegalNet, Inc. www.FormsWorkFlow.com Ros 5d-p-267