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D this form carefully. All checked boxes T are court orders. 4 The court grants your request for a hearing on your eligibility for a fee waiver. Go to your court hearing on the date below. You may bring information about your financial situation to the hearing. Hearing Date: Dept.: Date Fill in case number and case name: Case Number: Case Name: Name and address of court if different from above: Time: Rm.: The court denies your request for a hearing because (check all that apply): The hear.

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