What documents prove indigency?

Provide recent pay stubs, benefit award letters, bank statements, rent or mortgage receipts, and proof of public assistance when available. Courts may accept affidavits from third parties attesting to your financial situation; verify local rules for required document types and date ranges.

Do I need a notary or witnesses?

Some jurisdictions require a notarized affidavit; others accept unsworn declarations under penalty of perjury. Witness rules vary. Check the local court’s procedural rules; where allowed, Remote Online Notarization (RON) may be an option to avoid in-person notarization.

What happens if information changes?

If your financial situation changes materially after filing, notify the court and submit an amended affidavit or supplemental statement following local rules. Failure to update may affect eligibility, and submitting false or misleading information can have legal consequences including denial, sanctions, or criminal charges.

Can I eSign the affidavit?

Electronic signatures are generally acceptable under the ESIGN Act and UETA where the court permits electronic filings, but exceptions exist for certain documents. Confirm the court’s e-filing and signature policies; obtain consent and maintain an audit trail demonstrating intent, attribution, and retention.

How long does processing take?

Processing time varies by court and caseload; some clerks rule within days, others take weeks. If expedited review is required for deadline-driven filings, request accelerated consideration and provide documentation supporting urgency; follow local rules for expedited procedures and service.

Where to get legal help?

Contact local legal aid offices, public defender services, courthouse self-help centers, or bar association referral programs for advice and possible pro bono representation. If affordability is the issue, courts often post lists of free clinics or volunteer attorney programs on their websites or clerk offices.

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Affidavit of Indigency and Request for Waiver

Affidavit of Indigency and Request for Waiver

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Commonwealth of Massachusetts

AFFIDAVIT OF INDIGENCY

AND REQUEST FOR WAIVER, SUBSTITUTION
OR STATE PAYMENT OF FEES & COSTS

(Note: If you are currently confined in a prison or jail and are not seeking immediate release under G.L. c. 248 §1, but
you are suing correctional staff and wish to request court payment of “normal” fees (for initial filing and service), do not
use this form. Obtain separate forms from the clerk.)

Court

Case Name and Number (if known)

Name of applicant:

Address:

(Street and number)

(City or town)

(State and Zip)

SECTION 1:

Under the provisions of General Laws, Chapter 261, Sections 27A-27G, I swear (or affirm) as follows:
I AM INDIGENT in that (check only one ):

(A) I receive public assistance under (check form of public assistance received):

Transitional Aid to Families with Dependent Children (TAFDC)

Medicaid (MassHealth)

Emergency Aid to Elderly, Disabled or Children (EAEDC)

Supplemental Security Income (SSI)

Massachusetts Veterans Benefits Programs; or

(B) My income, less taxes deducted from my pay, is $ per week biweekly month year

(check the period that applies) for a household of persons, consisting of myself and dependents;

which income is at or below the court system's poverty level; (Note: The court system's poverty levels for households
of various sizes must be posted in this courthouse. If you cannot find it, ask the clerk or check online at:
http://www.mass.gov/courts/sjc/docs/povertyguidelines.pdf. The court system's poverty level is updated each year.)

(List any other available household income for the checked period on this line: $ ); or

(C) I am unable to pay the fees and costs of this proceeding, or I am unable to do so without depriving myself
or my dependents of the necessities of life, including food, shelter and clothing.

IF YOU CHECKED (C), YOU MUST ALSO COMPLETE THE SUPPLEMENT TO THE AFFIDAVIT OF
INDIGENCY.

SECTION 2: (Note: In completing this form, please be as specific as possible as to fees and costs known at the time of
filing this request. A supplementary request may be filed at a later time, if necessary.)

I request that the following NORMAL FEES AND COSTS be waived (not charged) by the court, or
paid by the state, or that the court order that a document, service or object be substituted at no cost (or a
lower cost, paid for by the state): (Check all that apply and, in any "$" blank, indicate your best
guess as to the cost, if known.)

Filing fee and any surcharge. $

Filing fee and any surcharge for appeal. $

Fees or costs for serving court summons, witness subpoenas or other court papers. $

Other fees or costs of $ for (specify):

Substitution (specify):

SECTION 3:

I request that the following EXTRA FEES AND COSTS either be waived (not charged), substituted or
paid for by the state:

Cost, $ of expert services for testing, examination, testimony or other assistance (specify):

Cost, $ of taking and/or transcribing a deposition of (specify name of person):

Cassette copies of tape recording of trial or other proceeding, needed to prepare appeal for applicant not
represented by Committee for Public Counsel Services (CPCS-public defender).

Appeal bond

Cost, $ of preparing written transcript of trial or other proceeding

Other fees and costs, $ for (specify):

Substitution (specify)

Date signed

Signed under the penalties of perjury

By order of the Supreme Judicial Court, all information in this affidavit is CONFIDENTIAL. Except by special
order of a court, it shall not be disclosed to anyone other than authorized court personnel, the applicant,
applicant's counsel or anyone authorized in writing by the applicant.

This form prescribed by the Chief Justice of the SJC pursuant to G.L. c. 261, § 27B. Promulgated March , 2003.
Fillable PDF created August 2013.

What the Affidavit of Indigency and Request for Waiver Is

The Affidavit of Indigency and Request for Waiver is a sworn statement used to request exemption from court filing fees and related costs when a filer cannot afford them. It describes the filer’s financial situation, income, assets, monthly expenses, and household obligations, and asks the court to waive fees or accept reduced charges. Courts and clerks evaluate the affidavit alongside supporting documents such as pay stubs or benefit statements. The affidavit must be accurate, signed under penalty of perjury, and completed according to local court rules to be considered for a fee waiver.

Why this affidavit matters for access to the court

An Affidavit of Indigency and Request for Waiver lets qualifying filers ask a court to waive filing fees, reducing financial barriers to access the justice system. Properly completed, it can preserve legal rights while minimizing upfront costs for low-income individuals.

Who commonly completes this affidavit

Typical users include self-represented litigants, legal aid and public interest organizations, and court clerks assisting low-income filers.

Individuals with limited income and assets seeking to file civil or family court matters.
Inmates filing motions or appeals who cannot pay filing or transcript fees.
Nonprofits, legal clinics, and pro bono attorneys helping eligible clients obtain fee waivers.

Step-by-step: completing and submitting the affidavit

Follow these sequential steps to complete and submit the affidavit to the appropriate court or agency.

01

Gather Documents: Collect pay stubs, benefits letters, and bank statements.
02

Complete Form: Fill each field clearly, use MM/DD/YYYY for dates.
03

Sign Under Oath: Sign the affidavit and date it before submission.
04

File with Clerk: File at the clerk’s office or follow e-filing instructions.

How the waiver request progresses through the court

This high-level workflow shows how the affidavit moves from completion to court decision on the waiver request.

Prepare: Complete affidavit fields and assemble supporting documents.
Notarize: If required, sign before a notary or follow RON procedures.
Submit: File the affidavit with court clerk or upload electronically.
Decision: Clerk or judge reviews materials and issues a ruling.

Online workflow settings to collect affidavits securely

Configure an online workflow to collect, verify, and submit affidavits securely and with minimal manual steps.

Required Online Workflow Field Name	Configuration and validation settings governing field behavior during submission
Applicant Identification and Contact Fields	Collect full name, DOB, address, phone, and email for verification.
Income, Asset, and Benefit Inputs	Enter monthly amounts, benefit types, and bank balances with dates.
Supporting Document Upload and Labeling	Allow PDF, JPG, PNG uploads; require filename and date metadata.
Signature Capture, Notarization and Audit Trail	Enable eSignature, RON options, and retain an audit trail of actions.

Technical considerations for eSubmission and storage

Platforms used to collect and submit the affidavit should support secure uploads, conditional fields, and signer authentication methods.

File Types: PDF, DOCX, JPG accepted.
Authentication: Email OTP, SMS code, or ID verification.
Integrations: Works with court e-filing and records systems.

Timelines and typical processing timeframes

Key timing considerations affect when to file the affidavit, when supporting documents should be dated, and how quickly courts typically process fee-waiver requests.

When to File:

File with initial pleading or immediately upon fee assessment.

Supporting Document Dates:

Provide the most recent documents within 30 to 90 days.

Clerk Processing Time:

Clerk may issue decision within days to weeks depending on caseload.

Emergency Requests:

Request expedited consideration for imminent deadlines or imminent harm.

Appeals or Objections:

Opposing parties may object; follow local rules for notices and hearings.

Common preparation errors to avoid

Failing to attach current supporting documents such as recent pay stubs or benefit letters often causes denials or delays in fee-waiver approval.
Incomplete financial disclosures, omitted household members, or understated income can result in rejection or prosecution for false statements.
Using vague language without specifying monthly amounts or recurring obligations reduces the affidavit’s credibility and may prompt requests for clarification.
Submitting an unsigned or improperly notarized affidavit can cause immediate administrative rejection and require resubmission.

Consequences and legal risks of inaccurate affidavits

Perjury Risk: Perjury penalties may apply.

Denial of Waiver: Court may deny waiver.

Fee Assessment: Fees may be assessed later.

Criminal Liability: False affidavit can lead to charges.

Delay in Case: Proceedings may be postponed.

Professional Advice: Consult counsel for disputed eligibility.

Six core components of a professional affidavit

A professional Affidavit of Indigency and Request for Waiver clearly documents eligibility, summarizes finances, and provides legally sufficient attestations for court review.

Declaration

A sworn declaration that states under penalty of perjury the filer’s financial circumstances, household composition, sources of income, and any special expenses affecting ability to pay filing fees.

Financial Breakdown

Itemized monthly figures for income and expenses, including wages, government benefits, child support, rent or mortgage payments, utilities, medical costs, transportation, and loan obligations outstanding.

Asset Disclosure

A clear list of cash on hand, bank balances, vehicles, real property, investments, and other assets the filer controls, with approximate valuations and account dates.

Household Information

Names and relationships of household members, number of dependents, and any shared income or expenses that affect monthly disposable income and eligibility assessment by court.

Supporting Evidence

Attach verifiable documents such as recent pay stubs, benefit award letters, bank statements, proof of rent or mortgage, and any medical bills or special-need documentation.

Signature Block

Signature, printed name, and date of the affiant; include notary or jurat language where required, and provide contact information for follow-up and counsel contact details.

Pricing and capability comparison for common eSignature vendors

Compare common pricing and capability points for eSignature vendors in workflows that include Affidavit of Indigency and Request for Waiver processing.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	Yes
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	No public cap noted	No public cap noted	No public cap noted

Frequently asked questions about the affidavit and filing

Frequently asked questions address common issues when completing, signing, notarizing, and filing an Affidavit of Indigency and Request for Waiver.

Need help? Contact support

What documents prove indigency?
Provide recent pay stubs, benefit award letters, bank statements, rent or mortgage receipts, and proof of public assistance when available. Courts may accept affidavits from third parties attesting to your financial situation; verify local rules for required document types and date ranges.
Do I need a notary or witnesses?
Some jurisdictions require a notarized affidavit; others accept unsworn declarations under penalty of perjury. Witness rules vary. Check the local court’s procedural rules; where allowed, Remote Online Notarization (RON) may be an option to avoid in-person notarization.
What happens if information changes?
If your financial situation changes materially after filing, notify the court and submit an amended affidavit or supplemental statement following local rules. Failure to update may affect eligibility, and submitting false or misleading information can have legal consequences including denial, sanctions, or criminal charges.
Can I eSign the affidavit?
Electronic signatures are generally acceptable under the ESIGN Act and UETA where the court permits electronic filings, but exceptions exist for certain documents. Confirm the court’s e-filing and signature policies; obtain consent and maintain an audit trail demonstrating intent, attribution, and retention.
How long does processing take?
Processing time varies by court and caseload; some clerks rule within days, others take weeks. If expedited review is required for deadline-driven filings, request accelerated consideration and provide documentation supporting urgency; follow local rules for expedited procedures and service.
Where to get legal help?
Contact local legal aid offices, public defender services, courthouse self-help centers, or bar association referral programs for advice and possible pro bono representation. If affordability is the issue, courts often post lists of free clinics or volunteer attorney programs on their websites or clerk offices.

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