"In that _____________________ did, (at) (on board) _____________________, on or about _____________________ 19__, wrongfully or falsely [(sell to _____________________)] [(give to _____________________)] [(loaned to _____________________)] [(dispose of by _____________________)] [(a certain instrument purporting to be) (a) (an) (another's) (naval) (military) (official) (pass) (permit) (discharge certificate) (identification card) (_____________________) in words and figures as follows: _____________________, [he/she, then said _____________________, then well knowing the same to be (false) (unauthorized) (_____________________)."
_____________________19__, wrongfully or falsely [(sell to_____________________)] [(give to_____________________)] [(loaned to_____________________)] [(dispose of by
Haw. Code R. § 7-9-13