Fill and Sign the Fw 011 V6 031109 Cleanofm Form

FW-011 Cler k stamps date her e when form is fi led. Street or mailing address : Zip: State: City: The cour t has information that (check all that ap ply): a. Yo ur finan cial situatio n may hav e chan ge d, or you may no longer be eligible for a fee wa iver bec ause (explain): You may be increa sing the cost s of your case unnecessa rily. The fee waiver for the court services you are using may be limited bec ause (explain): Your case is coming to an end, and the court requires some information ab out your eligibility to have your court fe es waived. c. You mu st go to c ourt o n th e da te b elow: Bring the following information if reasona bly available: Date: Signature of (check one): Judicial Officer Clerk, Deputy Request fo r Accommodations. As sis tive listening systems, computer-as siste d real-time captioning, or sign language interpreter services are available if you ask at least five days before your hearing. Contact the clerk’s office for Reques t for Accommodation, form MC-410. (Civil Code, § 54.8.) Notice to Appear for Reconsideration of Fee Waiver FW -011 , Page 1 of 1 New Ju ly 1, 2009, Ma ndator y Fo rm Government Code, § 68 636 Notice to Appear for Reconsideration of Fee Waiver Na me and address of court if different from above: Date: Time: Dept.: Rm.: He aring Dat e Î Nam e of perso n who ask ed th e co urt to wa ive cou rt fees : 14 Lawye r, if p erson in has one: (Name, address, phone number, e-mail, and State Bar number): 231 b. I certify that I am not i nvolved in this c ase and (check one): Clerk's Certificate of Service This not ice wa s maile d firs t class, postage paid, to th e party and attorney, if any, at the addresses listed in and , Date: from (city): , Calif ornia on t he date below. Cl erk, by , Dep uty 12 A cert ificate of mailing is attached. Warning: If you do not go to the hearin g on the date and t ime below, the court may cancel your fee waive r. I han ded a copy of this no tice to the party and attorney, if any, listed in and , at the cour t, on the date below. 12 Fill in cour t na me and street add ress: Fill in ca se numbe r and na me: Case Number: Case Name: Su perio r Co urt of Cali forn ia, Cou nty o f Judicial Council of California