Fill and Sign the Determination Regarding Fees and Costs Form

DETERMINATION REGARDING FEES AND COSTSCommonwealth of Massachusetts Juvenile Court DepartmentDIVISION Case Name: Docket No. DETERMINATION REGARDING FEES AND COSTSName of Applicant: _____________________________________________________________ Address ____________________________________________________________________________ DETERMINATION BY CLERK G ALLOWED FORTHWITH. The applicant’s affidavit appears regular and complete on its face, indicates that the applicant is indigent, and requests waiver, substitution or payment by the Commonwealth of normal fees and costs only. Pursuant to G.L. c. 261, §27C(2), the application is therefore ALLOWED forthwith without hearing, and the normal fees and costs indicated in the application are: G waived in full G to be paid by the Commonwealth in the amount of $ ________________ G REFERRED TO A JUDGE. The applicant’s affidavit does not satisfy all the conditions of § 27C(2), and is therefore referred to a judge pursuant to § 27C(3), because: G The affidavit is not regular on its face. G The affidavit does not indicate that the applicant is indigent within the meaning of § 27A. G The affidavit request waiver, substitution or payment by the Commonwealth of extra fees and costs. Comments: Describe fees and costs waived: Date: Clerk-Magistrate/Assistant Clerk X DETERMINATION BY JUDGE G AFTER HEARING G WITHOUT A HEARING NORMAL FEES AND COSTSG The application is allowed with respect to the normal fees and costs indicated in the application, and they are ordered: G Filing Fee and any surcharge for appeal. $______________ G Fees or costs for serving court summons, witness subpoenas or other court papers. $____________ G Other fees or costs of $__________ for (specify): ______________________________________________ ______________________________________________________________________________________ G Substitution (specify) _____________________________________________________________________ ______________________________________________________________________________________ (over) JV-IND-3 (11/2005) DETERMINATION BY JUDGE EXTRA FEES AND COSTSSection 3:I request that the following EXTRA FEES AND COSTS either be waived (not charged), substituted or paid by the state: G Cost, $________, of expert services for testing, examination, testimony or other assistance (specify): ______________________________________________________________________________________ G Cost, $________, of taking and/or transcribing a deposition of (specify name of person): __________________ G 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). G Appeal bond G Cost, $________, of preparing written transcript of trial other proceeding G Other fees and costs, $________, for (specify) _________________________________________________ ______________________________________________________________________________________ G Substitution (specify) _____________________________________________________________________ ______________________________________________________________________________________ Describe extra fees and costs waived: Date Judge X The applicant may appeal denial of this application by filling a notice of appeal with the clerk of this court within days from notice of denial. This form prescribed by the Chief Justice of the Supreme Court pursuant to G.L. c. 261, §27B. Promulgated March 2003)