NO. _________ IN THE (SUPREME COURT or INTERMEDIATE COURT OF APPEALS) OF THE STATE OF HAWAI`I _______________________________, Plaintiff-_____________, v. ______________________________, Defendant-___________. __________________________________ ) ____________ NO. _______ ) ) ) ) ) ) ) ) ) REQUEST AND DECLARATION OF COUNSEL In accordance with Hawaii Rules of Appellate Procedure (HRAP) Rule 39(d), I, ___________________________, attorney for __________________, request compensation for costs and attorneys' fees and, in conjunction herewith aver, as follows: 1. (Appellant or Appellee) prevailed in this appeal. 2. I request reimbursement for necessary and authorized costs as follows: Item Amount Authority a. $ ____________ b. c. d. _ TOTAL COSTS $ ____________ $ ____________ $ ___________ $ A true and correct itemized accounting of these costs, including relevant invoices and receipts, is attached as Appendix A. HRAP Form 8 (09/10) Page 1 American LegalNet, Inc. www.FormsWorkFlow.com 3. I have expended the following hours in attorney work and, pursuant to Hawaii Revised Statutes § or , am entitled to charge the following amounts for this appeal: Activity a. Correspondence, Interviews and Conferences b. Obtaining & Reviewing Records c. Legal Research d. Drafting e. Oral Argument (In-court) f. Other (Specify) TOTAL FEES Hours ______ ______ ______ ______ ______ ______ ______ Amount $ _______ $ _______ $ _______ $ _______ $ _______ $ _______ $ _______ @ $ _______ @ $ _______ @ $ _______ @ $ _______ @ $ _______ @ $ _______ Attached hereto as Appendix B are hourly worksheets, prepared in accordance with HRAP Form 8 and contemporaneously with the work performed as noted thereon and truthfully reflecting the amount of work actually performed in the representation of Appellee) (Appellant or . Additional information [including the language of the contract authorizing attorneys' fees] and authority [including appropriate case authority] supporting my request for costs and attorneys' fees is included in the memorandum of law attached hereto. I, _______________________, declare under penalty of law, as provided by HRAP Rule 52, that the foregoing is true and correct. DATED: ______________________________________________. __________________________________ HRAP Form 8 (09/10) Page 2 American LegalNet, Inc. www.FormsWorkFlow.com