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Get CA FW-001 (formerly 982(a)(17)) 2024

Why are you asking the court to waive your court fees a. Food Stamps I receive check all that apply see form FW-001-INFO for definitions Supp. Sec. Inc. SSP County Relief/Gen. Assist. If yes your lawyer must sign here Lawyer s signature If your lawyer is not providing legal-aid type services based on your low income you may have to go to a hearing to explain why you are asking the court to waive the fees. I ask the court to check one and you must fill out page 2 waive all court fees and costs waive some of the court fees let me make payments over time Check here if you asked the court to waive your court fees for this case in the last six months. FW-001 Request to Waive Court Fees CONFIDENTIAL Clerk stamps date here when form is filed. If you are getting public benefits are a low-income person or do not have enough income to pay for your household s basic needs and your court fees you may use this form to ask the court to waive your court fees. The court may also charge you any collection costs. 1 Your Information person asking the court to waive the fees Name Street or mailing address Fill in case number and name City State Zip Case Number Phone 2 Your Job if you have one job title Case Name Name of employer Employer s address Your Lawyer if you have one name firm or affiliation address phone number and State Bar number a. The lawyer has agreed to advance all or a portion of your fees or costs check one Yes No b. The court may order you to answer questions about your finances. If the court waives the fees you may still have to pay later if You cannot give the court proof of your eligibility Fill in court name and street address Your financial situation improves during this case or Superior Court of California County of You settle your civil case for 10 000 or more. The trial court that waives your fees will have a lien on any such settlement in the amount of the waived fees and costs. What court s fees or costs are you asking to be waived Supreme Court Court of Appeal or Appellate Division of Superior Court See Information Sheet on Waiver of Appellate Court Fees form APP-015/FW-015-INFO. IHSS CalWORKS or Tribal TANF CAPI Medi-Cal b. My gross monthly household income before deductions for taxes is less than the amount listed below. If you check 5b you must fill out 7 8 and 9 on page 2 of this form* Family Size Family Income 1 264. 59 1 714. 59 3 064. 59 3 514. 59 If more than 6 people at home add 450. 00 for each extra person* I do not have enough income to pay for my household s basic needs and the court fees. If your previous request is reasonably available please attach it to this form and check here I declare under penalty of perjury under the laws of the State of California that the information I have provided on this form and all attachments is true and correct. Date c* Print your name here Judicial Council of California www. courts. ca*gov Revised March 2 2018 Mandatory Form Government Code 68633 Cal* Rules of Court rules 3. 51 8. 26 and 8. 818 Sign here FW-001 Page 1 of 2 Your name If you checked 5a on page 1 do not fill out below.

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