Legal Fee Waiver Notice

LEGAL FEE WAIVER NOTICE

This Legal Fee Waiver Notice (the "Notice") is made effective as of by and between Issuing Entity Name: with principal place of business at ("Issuing Entity"), and Applicant Name: whose address is ("Applicant").

RECITALS

WHEREAS, Applicant has applied to Issuing Entity for relief from specified legal fees associated with case or matter identified as Case Number: ; and

WHEREAS, Issuing Entity has authority under its governing standards and discretion to grant a waiver of fees in whole or in part subject to the terms and conditions set forth herein; and

WHEREAS, Applicant has submitted documentation and declarations in support of the request for waiver and warrants the truthfulness of the representations made in those submissions.

NOW, THEREFORE

In consideration of the mutual covenants and agreements set forth in this Notice, Issuing Entity and Applicant hereby agree as follows:

1. GRANT OF WAIVER

1.1 Issuing Entity hereby grants to Applicant a waiver of the following fees: Full waiver Partial waiver (if partial, state amount below).

1.2 Waiver Amount: . This waiver applies only to the fees expressly identified in this Notice and does not apply to attorney's fees, sanctions, fines, or other costs unless expressly stated herein.

1.3 Application: The waiver shall be applied to fees assessed in relation to the case or matter identified above and shall take effect on the Effective Date specified herein.

2. CONDITIONS AND LIMITATIONS

2.1 Documentation: The waiver is conditioned upon Applicant's continued provision of accurate financial information and supporting documentation as reasonably requested by Issuing Entity. Issuing Entity may verify information provided by Applicant with third parties.

2.2 Misrepresentation; Reimbursement: If Issuing Entity determines that Applicant knowingly made a material misrepresentation or omission in connection with the waiver request, Issuing Entity may rescind the waiver and require repayment of waived fees. Repayment shall accrue interest at the lesser of the statutory rate permitted by law or 10% per annum from the date of demand, and Applicant shall be liable for reasonable collection and legal costs incurred by Issuing Entity in enforcing repayment.

3. REPRESENTATIONS AND WARRANTIES OF APPLICANT

3.1 Applicant represents and warrants under penalty of perjury that all information provided in support of this waiver request is true, correct, and complete to the best of Applicant's knowledge. Applicant agrees to promptly notify Issuing Entity of any material change in circumstances that could affect eligibility for the waiver.

4. RELEASE AND LIMITATION OF LIABILITY

4.1 Applicant acknowledges that the waiver is an administrative determination and, except as expressly provided herein, Issuing Entity makes no other representations or warranties regarding Applicant's matter. Issuing Entity shall not be liable to Applicant for any consequential or incidental damages arising from the waiver decision, except to the extent such liability cannot be limited by law.

5. EFFECTIVE PERIOD AND TERMINATION

5.1 Term: This waiver remains effective until the fee to which it applies has been satisfied, until rescinded under Section 2.2, or until terminated by mutual written agreement of the parties. Termination shall not affect obligations accrued prior to termination.

6. NOTICES

All notices, requests, demands and other communications under this Notice must be in writing and delivered to the addresses below by hand, nationally recognized overnight courier, or registered mail (postage prepaid):

7. AMENDMENT; WAIVER

7.1 No amendment to this Notice will be effective unless in writing and signed by both parties. No waiver by either party of any breach or default will be deemed a waiver of any subsequent breach or default.

8. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

8.1 Governing Law: This Notice shall be governed by and construed in accordance with the laws of the state specified by Issuing Entity and consistent with any applicable federal law where applicable. The parties submit to the exclusive jurisdiction of the courts located in the governing jurisdiction for purposes of any dispute arising from or relating to this Notice.

8.2 Entire Agreement: This Notice contains the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, inducements and conditions, oral or written.

8.3 Severability: If any provision of this Notice is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect and shall be construed so as to effectuate the intent of the parties as closely as possible.

9. MISCELLANEOUS

9.1 Counterparts: This Notice may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

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