Fill and Sign the Fw 010 California Courts Cagov Form

You r Informatio n (per son with a fee waiv er): Name: Stre et or mailing address: Zip: Stat e: City: Phone number: You r lawyer, if yo u ha ve on e (name, address, phone number, e-mail, and State Bar number: Date of yo ur last court fee waiver order in this case : (date) My financial situation ha s changed since the date of the last court fee waiver order in a way that improves my ability to pay fees. I ask the co urt to do one of the following: a. End my fee waiver be cause my financial situa tion has improved and I am able to pa y my court fees and costs that are due after (date) : . b. Review my updated financial inf ormation in the att ached Reques t to Waive Court Fees . I believe I am still eligibl e for a fee waiver. (Comp lete fo rm FW -001 an d att ach to th is fo rm. ) My case has settled for (check one) less than $10,000 $1 0,00 0 or mo re (if so, complete a and b below.) I d eclare un der penalty of perjury und er the laws o f the Sta te of California that the inform ation abov e is true and correc t. Date: Print your name here Sign he re FW- 010 , Page 1 of 1 CONFIDENTIAL Notice to Court of Improved Financial Situati on or Settlement Cler k s tamps da te here when form is filed. FW-010 a. I (check one) have have not received the proceeds of the sett lement. b. The name and address of the party who has agreed to pay the settlement: Notice to Court of Improved Financial Situation or Settlement New July 1, 2009, Mandatory Form Gov ernm ent C ode, § 68 636(a ) Notice: The court may order you to answ er qu estions about your finances and later order you to pay ba ck the waived fees. If this happens and you do not pa y, the court can make you pay the fe es an d also cha rge you collection fees. If there is a change in your financial circumstances during this case that increases yo ur ability to pay fees and costs , you must noti fy the t rial court within five days. (Use for m FW-0 10.) If yo u win y our ca se, the trial cou rt ma y ord er the other side to pay the fees. If you se ttle your civil case for $1 0,0 00 or more, t he t rial court will ha ve a lien on the settlement in the amount of the waived fees. The tria l court may not dismiss th e case until the lie n is paid. 12345 Case Nu mber: Case Nam e: Su peri or Co urt of Ca liforn ia, Coun ty o f Fill out cour t nam e and street address: Fill out case number and ca se name: Judicial Co uncil of California