Stipulation for DiSmiSSal in the DiStrict court of the fifth circuit State of hawai`i Plaintiff(s) Form #5DC21 Reserved for Court Use Civil No. Defendant(s) Filing Party(ies)/Filing Party(ies)' Attorney (Name, Attorney Number, Firm Name (if applicable), Address, Telephone and Facsimile Numbers) Court Date & Time: Return Pre-Trial None Disposition/Other Trial Stipulation for DiSmiSSal Plaintiff(s) and Defendant(s) Stipulate for the Entry of Dismissal in the above-entitled case (select one) WitH WitHout prejudice pursuant to District Court Rules of Civil Procedure, Rule 41 (a)(l)(ii). This Stipulation for Dismissal is being signed by all parties who have appeared in this action. (select one) Partial Dismissal as to Defendant(s) _____________________________________________________________________________ (Certificate of Service required on other Defendant(s)) By signing this document, I/we acknowledge that there are no remaining claims on parties. Signature of Plaintiff(s)/Plaintiff(s)' Attorney: Date: Print/Type Name: Signature of Plaintiff(s)/Plaintiff(s)' Attorney: Date: Print/Type Name: Signature of Defendant(s)/Defendant(s)' Attorney: Print/Type Name: Signature of Defendant(s)/Defendant(s)' Attorney: Date: 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. RepRogRaphics (07/09) American LegalNet, Inc. www.FormsWorkFlow.com Dismstip 5D-p-183 Date: