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Receipt & Acknowledgment

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					Receipt and Acknowledgement

Bank/Company, hereby acknowledges receipt of check No. dated , in the amount of One

Hundred Thirty Four Dollars and 54 cents ($134.54), from the State of Hawaii, pursuant to the Garnishee Order entered on in

the matter entitled, Bank’s/Company Name vs. Customer’s name, Civil No. , in the District Court of the First Circuit, Honolulu Division, State of Hawaii.

Dated: Honolulu, Hawaii, September 11, 2001

________________________ Authorized Person’s Name Company Name Department Name


				
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