Complaint Form Hawaii Page 2
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1
2COMPLAINT (continued)
9. The Servicemembers Civil Relief Act, 50 U.S.C. App. §501 may apply to a Defendant who is classified active duty as defined in the Act.
Please check all that apply.
❑
To the best of my knowledge, the Defendant is not an active duty member of the Military.
❑
The following Defendant is an active duty member of the Military. Name:
❑
I am unable to determine whether the Defendant is an active duty member of the Military. Please attach separate sheet indicating
what attempt was made to determine Defendant’s military status.
10. As of (date):
Defendant(s) owed Plaintiff(s)
$
for:
❑
Rent itemized as follows:
❑
Other:
Plaintiff is asking the Court for the following:
A. A Judgment giving Plaintiff possession of the premises.
B. A Writ of Possession directing the Sheriff or Police Officer to:
1. Remove Defendant from the premises and all persons possessing the premises through Defendant;
2. Remove from the premises all personal belongings of Defendant and of any other person; and
3. Put Plaintiff(s) in possession of the premises.
C. Judgment against Defendant for
$
.
In addition, the Court may award additional rent and other charges owed under the rental agreement, damages, court costs,
interest, and reasonable attorney’s fees.
Signature of Plaintiff(s)/Plaintiff(s) Attorney:
Date:
Print/Type Name(s):
DECLARATION
I DECLARE UNDER PENALTY OF PERJURY THAT WHAT IS STATED IN THE COMPLAINT IS TRUE AND CORRECT.
Signature of Declarant:
Date:
Print/Type Name(s):
In accordance with the Americans with Disabilities Act , and other applicable State and Federal laws, if you require an accommodation for
your disability when working with a court program, service, or activity please contact the District Court Administration Office at PHONE NO.
244-2800, FAX 244-2849, OR TTY 244-2889 at least (10) working days before your preceeding, hearing, or appointment date.
For Civil related matters, please call 244-2706 or visit the Service Center at 2145 Main Street, Room 141A, Wailuku, Hawai‘i 96793.
(Rev 4/8/15)
Reprographics (05/11)
Page 2 of 2
COMPASP
2D-P-221
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