Form 1DC05 "Small Claims - Statement of Claim and Notice for Security Deposit Disputes" - Hawaii

What Is Form 1DC05?

This is a legal form that was released by the Hawaii District Courts - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2020;
  • The latest edition provided by the Hawaii District Courts;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 1DC05 by clicking the link below or browse more documents and templates provided by the Hawaii District Courts.

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Download Form 1DC05 "Small Claims - Statement of Claim and Notice for Security Deposit Disputes" - Hawaii

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Small Claims – Statement of claim and notice for
security deposit disputes (#1DC05)
In the Small Claims Division of the
District Court of the First Circuit
_________________________________ Division
Choose One
State of Hawaiʻi
Please read these instructions before you start the form
How to use this form
Use this form to file a small claims case if you want your landlord to
return the security deposit from a residential lease.
When you file this form, you are called the Plaintiff. Your landlord will be
the Defendant.
Case number:
This form is 3 pages and has 2 parts:
Part I: The Statement of Claim, including your sworn statement about your situation (called a Declaration).
Fill out Part I to give the Court the details about your case and to tell the Court what you would like to happen.
Part II: A Notice of Hearing. The Court Clerk will use this part of the form to schedule a hearing for your case. At the hearing, you
will be able to present evidence and tell the Judge why you should win this case. The Defendant will have the same
opportunity.
When you have finished the form and the Court has scheduled a hearing, you must deliver a copy of the full form to the Defendant.
You can find more information on the Service of Process Information Sheet.
Part I
S
C
TATEMENT OF
LAIM
1
Give the Court your contact information and as much of your landlord’s contact information as you can.
Your
Landlord’s
name:
name:
Your full
Landlord’s
address,
full address,
telephone
telephone
number,
number, and
and email:
email:
2
Give the Court information about the money that your landlord owes you.
Month
Day
Year
My landlord owes me this much
I moved out on this
$
of my deposit:
date:
This is why my
landlord owes
me the money:
(Add another sheet
if necessary)
1
1D-P-1037
RG-AC-508 (05/2020)
Small Claims – Statement of claim and notice for
security deposit disputes (#1DC05)
In the Small Claims Division of the
District Court of the First Circuit
_________________________________ Division
Choose One
State of Hawaiʻi
Please read these instructions before you start the form
How to use this form
Use this form to file a small claims case if you want your landlord to
return the security deposit from a residential lease.
When you file this form, you are called the Plaintiff. Your landlord will be
the Defendant.
Case number:
This form is 3 pages and has 2 parts:
Part I: The Statement of Claim, including your sworn statement about your situation (called a Declaration).
Fill out Part I to give the Court the details about your case and to tell the Court what you would like to happen.
Part II: A Notice of Hearing. The Court Clerk will use this part of the form to schedule a hearing for your case. At the hearing, you
will be able to present evidence and tell the Judge why you should win this case. The Defendant will have the same
opportunity.
When you have finished the form and the Court has scheduled a hearing, you must deliver a copy of the full form to the Defendant.
You can find more information on the Service of Process Information Sheet.
Part I
S
C
TATEMENT OF
LAIM
1
Give the Court your contact information and as much of your landlord’s contact information as you can.
Your
Landlord’s
name:
name:
Your full
Landlord’s
address,
full address,
telephone
telephone
number,
number, and
and email:
email:
2
Give the Court information about the money that your landlord owes you.
Month
Day
Year
My landlord owes me this much
I moved out on this
$
of my deposit:
date:
This is why my
landlord owes
me the money:
(Add another sheet
if necessary)
1
1D-P-1037
RG-AC-508 (05/2020)
3
Read the information below and then sign the Declaration.
I would like the Court to order my landlord to pay me the amount I listed on the first page.
I would also like the Court to order my landlord to pay me interest, costs, and fees that the Court believes are
just and reasonable. I understand that if the Judge finds that my landlord wrongfully and willfully kept all or
part of my security deposit, the Judge may order the landlord to pay me three times the security deposit, which
is allowed by Hawaiʻi Revised Statutes § 521-44(h).
P
D
LAINTIFF
S
ECLARATION
The information in this claim is true and correct. I understand that I may be prosecuted for perjury if I
have stated anything in this form that I know is not true.
Your
Today’s date:
signature:
Part II
N
H
OTICE OF
EARING
Fill in the landlord’s name below and then take or mail the form to the Court. Court staff will schedule a hearing
4
and will fill out the rest of Part II.
To:
(Landlord’s name)
The Plaintiff has filed this Statement of Claim. A Judge will review evidence and hear arguments from both the Plaintiff
and the Defendant at the place and time stated here:
Place:
Honolulu Division
Kauikeaouli Hale - 1111 Alakea Street, Honolulu – 10th Floor
̒ E wa Division
870 Fourth Street, Pearl City, Honolulu, Hawai‘i
Ko‘olaupoko/Ko‘olauloa Division
45-939 Po‘okela Street, Kāne‘ohe, Hawai i
Wahiawā or Waialua Division
1034 Kilani Avenue, Wahiawā, Hawai‘i
Wai‘anae Division
4675 Kapolei Parkway, Kapolei, Hawai‘i
Date & time:
If you need to mail or deliver anything to the Court, use this address, even if your hearing is at another location:
1111 Alakea Street, Honolulu, Hawai`i 96813 – Third Floor
Clerk’s
Today’s date:
signature:
Clear form
2
Here is more information to help both parties prepare for the hearing.
What if I don’t come to the hearing?
If you are the landlord and you do not come to the hearing, the Court may order you to pay the Plaintiff
the amount requested in the Statement of Claim. This is called a Default Judgment.
If you are the Plaintiff and you do not come to the hearing, the Court may dismiss your case.
May I hire an attorney?
No. An attorney may not represent either party in the Small Claims Division for security deposit cases.
May I bring witnesses and documents to support my case to the hearing?
Yes. If you plan to question witnesses, they must come to the hearing at the date and time shown
above.
You may also ask the Judge to look at documents that support your case. You must bring those
documents, with at least 2 copies, to the hearing.
How can I make sure my witnesses show up for the hearing?
The Court can help you make sure a witness comes to the hearing by issuing a subpoena. If you wish to
subpoena witnesses, contact the Court Clerk as soon as possible before the hearing.
If I lose the case, may I appeal it?
No. In a small claims action, the Judge’s decision is final. You MAY NOT appeal a judgment of the Small
Claims Division.
Instructions to the Plaintiff about delivering this form your Landlord.
You must deliver a full copy of this form to the Defendant, either by registered or certified mail, with restricted
delivery, or by personal service. Please read the Instructions on the Service of Process Information Sheet
carefully before you try to serve the Landlord.
Restriction on personal service: This claim may not be personally delivered between 10:00 p.m. and 6:00 a.m.
unless it is served at a location that is open to the public or unless a Judge of this Court, by written order,
permits personal delivery during those hours.
Americans with Disabilities Act Notice
If you need an accommodation for a disability when participating in a court program, service or
activity, please contact the ADA Coordinator as soon as possible to allow the court time to
provide an accommodation:
Call (808) 538-5121; or
Send an e-mail to adarequest@courts.hawaii.gov
The court will try to provide, but cannot guarantee, your requested auxiliary aid, service or
accommodation.
If you need help with this document, please contact the District Court Service Center at PHONE NO. (808) 538-5629 •
or VISIT at 1111 Alakea Street, Third Floor.
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