Name
Address
Tel. No.
Attorney for
IN THE CIRCUIT COURT OF THE ___________ CIRCUIT
STATE OF HAWAI‘I
) CIVIL NO. _________________________
)
) REQUEST TO EXEMPT CASE
) FROM THE COURT ANNEXED
) ARBITRATION PROGRAM;
Plaintiff(s), ) SUMMARY OF FACTS
)
vs. )
)
)
)
)
)
Defendant(s). )
_______________________________________)
REQUEST TO EXEMPT CASE FROM THE
COURT ANNEXED ARBITRATION PROGRAM
Comes now ______________________________________________________,
by and through (his/her/its/their) attorney(s), and hereby requests that the above entitled matter
be exempt from the Court Annexed Arbitration Program, as the probable jury award value, not
reduced by the issue of liability, and exclusive of attorney’s fees, interest and cost, is in excess of
$150,000.00.
This request is made pursuant to Rule 8 (A) of the Hawai‘i Arbitration Rules, as
amended, and the Summary of Facts attached hereto.
DATED: , Hawai‘i, ____________________________________.
_________________________________________
Attorney for
1C-P-524 (08/05)
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