Ka Wai Ola - Office of Hawaiian Affairs, Volume 12, Number 7, 1 Iulai 1995 — Page 9 Advertisements Column 2 [ADVERTISEMENT]

Kōkua No ke kikokikona ma kēia Kolamu

5- To the best of your ability, please providing the folIowing information. Attach extra sheets if necessary: (a) Brief description of the wrongsuffered; (b) Facts, circumstances, and dates involved; (e) Names and titles ofState employces who committed the wrong; (d) Monetary loss or damage you suffered; (e) What actions, beside money damages, would correct the wrong. Make a copy of this elaim form for your files. Mail or hand-deliver the original elaim form to:

Mail: HAWAIIAN CLAIMS OFFlCE P.O. Box 54 1 Honolulu, Llawaii 96809

Hand-deliver: HAWAIIAN CLAIMS OFFICE 828 Fort Street Mall, #600 Honolulu, Hawaii

The filing deadline is August 31, 1995 For information or help in filling out this elaim form, eall 586-2826 (O'ahu) or 1-800-481-0800 (Neighbor lslands)