"In that _____________________ did, (at) (on board) _____________________, on or about _____________________ 19__, wrongfully and falsely (make) (forge) (alter by _____________________) (counterfeit) (tamper with by _____________________) (a certain instrument purporting to be) (a) (an) (another's) (naval) (military) (official) (pass) (permit) (discharge certificate) (identification card) (_____________________) in word and figure as follows: _____________________, [he/she then said _____________________, then well knowing the same to be (false) (unauthorized) (_____________________)."
Haw. Code R. § 7-9-12