Return Of Service; Acknowledgment Of Service

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R
S
; A
S
Form #2DC47
etuRn of
eRvice
cknowledgment of
eRvice
i
t
d
c
S
c
n
he
iStRict
ouRt of the
econd
iRcuit
d
iStRict
S
h
‘
tAte of
AwAi
i
Plaintiff(s)
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:
ADDRESS WHERE SERVED:
NAME OF PARTY SERVED:
MILEAGE $
DATE SERVED:
NUMBER OF MILES TRAVELED:
TIME OF SERVICE
■
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.
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 Address, Telephone and Facsimile Numbers
Print/Type Name
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 Hawai‘i
RepRogRaphics (0/10)
Ros 2d-p-261
RevaComm 508 Certified
Page 1 of 2
(Rev 11/20/15)

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