Fill and Sign the District Court of Washington for Yakima County No Form

MT and Decl for Civi l Fee Waiver (QLSP) (MT WV F) - Page 1 of 2 WPF GR 3 4.0200 (07/201 9) – GR 3 4 Court of Washington For Petitioner /Plaintiff, vs. Respondent /Defendant. No . ________________________ Motion and Declaration For Waiver of Civil Fees and Surcharges (QLSP Filing) (MT WV F) I. Mot ion On behalf of the [ ] petitioner/plaintiff [ ] respondent/defendant, I am asking for a waiver of fees and surcharges under GR 34 . I base this motion on GR 34(a) and the declaration, below. Dated: Signature of Lawyer WSBA No. Print or Type Name II. Declaration I declare that, 2.1 I represent the [ ] petitioner/plaintiff [ ] respondent/defendant . 2.2 I am an attorney working with _____________________________, which is a Qualified Legal Services Provider (QLSP) as defined by the Was hington State Bar Association in APR 8(e)(2). 2.3 I am working with the QLSP as an: [ ] attorney employed by the QLSP, or [ ] attorney working in conjunction with the QLSP. MT and Decl for Civi l Fee Waiver (QLSP) (MT WV F) - Page 2 of 2 WPF GR 3 4.0200 (07/201 9) – GR 3 4 2.4 The QLSP screened the [ ] petitioner/plaintiff [ ] respondent/defendant and found the litigant eligible for free civil legal aid services. [ ] (Check if applies .) I filed this motion by mail. I enclosed a self -addressed stamped envelope for timely return of a conformed copy of the order. I declare under penalty of perjury u nder the laws of the state of Washington that the foregoing is true and correct. Signed at (city) ____________________, (state) ______ _ on (date) _____________________ . Signature of Lawyer WSBA No. Print or Type Name