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PLAINTIFF/ PETITIONER: DEFENDANT/ RESPONDENT: ORDER ON APPLICATION FOR WAIVER OF ADDITIONAL COURT FEES AND COSTS (Cal. Rules of Court, rule 985(j)) NOTICE: If item 3d or item 5b is filled in and the applicant does not attend the hearing, the court may revoke or change the order or deny the application without considering information the applicant wants the court to consider.WARNING: The applicant must immediately tell the court if he or she becomes able to pay court fees or costs during this action. The applicant may be ordered to appear in court and answer questions about his or her ability to pay fees or costs.                                    FW-004 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address):FOR COURT USE ONLYTELEPHONE NO.:FAX NO.:E-MAIL ADDRESS (Optional):ATTORNEY FOR (Name):SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS:MAILING ADDRESS:CITY AND ZIP CODE:BRANCH NAME:CASE NUMBER:1. The application was filed on (date): 2. The application was filed by (name):A previous order was issued on (date):3.IT IS ORDERED that the application is grantedin wholein part (complete item 4 below).a.b.No payments. Payment of all the fees and costs listed in California Rules of Court, rule 985(i), is waived. The applicant shall pay all the fees and costs listed in California Rules of Court, rule 985(i), EXCEPT the following:(1)Filing papers.(6)Sheriff and marshal fees.(2)Certification and copying.(7)Reporter's fees* (valid for 60 days).(3)Issuing process and certification.(8)(4)Transmittal of papers.(9)Telephone appearance (Gov. Code, § 68070.1 (c)) Other (specify code section):(5Court-appointed interpreter.Reporter's fees are per diem pursuant to Code Civ. Proc., §§ 269, 274c, and Gov. Code, §§ 69947, 69948, and 72195.c. Method of payment. The applicant shall pay all the fees and costs when charged, EXCEPT as follows:(1)Pay (specify):percent. (2)Pay: $per month or more until the balance is paid.d. The clerk of the court, county financial officer, or appropriate county officer is authorized to require the applicant to appear before and be examined by the court no sooner than four months from the date of this order, and not more than once in anyfour-month period.The applicant is ordered to appear in this court as follows for review of his or her financial status:Date:Time:Dept.:Div.:Room:e.The clerk is directed to mail a copy of this order only to the applicant's attorney or to the applicant if not represented.f. All unpaid fees and costs shall be deemed to be taxable costs if the applicant is entitled to costs and shall be alien on any judgment recovered by the applicant and shall be paid directly to the clerk by the judgment debtorupon such recovery.4.IT IS ORDERED that the application is denied of Court, rule 985):in wholein part for the following reasons (see Cal. Rulesa.Monthly household income exceeds guidelines (Gov. Code, § 68511.3(a)(6)(B); form 982(a)(17)(A)).b.Other (Complete line 4b on page 2).c. The applicant shall pay any fees and costs due in this action within 10 days from the date of service of this order or anypaper filed by the applicant with the clerk will be of no effect.d. The clerk is directed to mail a copy of this order to all parties who have appeared in this action.5.IT IS ORDERED that a hearing be held.a. The substantial evidentiary conflict to be resolved by the hearing is (specify):b. The applicant should appear in this court at the following hearing to help resolve the conflict:Date:Time:Dept.:Div.:Room:C. The address of the court is (specify):Same as aboved. The clerk is directed to mail a copy of this order only to the applicant's attorney or to the applicant if not represented.Date:Clerk, byI DeputyJUDICIAL OFFICER(Clerk may GRANT in full a nondiscretionary fee waiver; see Cal Rules of Court, rule 985(d)) Page 1 of 2Form Adopted for Mandatory Use Judicial Council of California FW-004 [Rev. January 1, 2007] Government Code, § 68511.3; Cal. Rules of Court, rule 985 e le ctr o nic f o rm  2 002 WWW.LawCA.com La w P ublis h ersORDER ON APPLICATION FOR WAIVER OF ADDITIONAL COURT FEES AND COSTS (in Forma Pauperis)   P LA IN TIF F/P ETIT IO NER ( N am e):C ASE N UM BER :D EFE N DAN T/R ESPO NDEN T ( N am e):4 bA pplic a tio n is d enie d in w hole o r in p art ( s p ecif y r e aso ns):CLERK'S CERTIFICATE OF MAILING, C alif o rn ia ,I c e rtif y t h a t I a m n ot a p arty t o t h is c a use a nd t h at a t r u e c o py o f t h e f o re goin g w as m aile d f ir s t c la ss, p osta ge p re paid , in a s e ale d enve lo pe a ddre sse d a s s h ow n b elo w , a nd t h at t h e m ailin g o f t h e f o re goin g a nd e xe cu tio n o f t h is c e rtif ic a te o ccu rre d a t (pla ce): on ( d ate ):C le rk , b yI Deputy(S EAL) C LE R K'S C ER TIF IC ATE I c e rtif y t h a t t h e f o re goin g is a t r u e a nd c o rre ct c o py o f t h e o rig in al o n f ile in m y o ffic e . D ate :C le rk , b yI DeputyF W -0 04 [R ev. J a nuary 1 , 2 007]P age 2 o f 2e le ctr o nic f o rm  2 002 WWW.LawCA.com La w P ublis h ersO RDER O N A PPLIC ATIO N F O R W AIV ER O F AD DIT IO NAL C O URT F E ES A ND C O STS (in F orm a P au peris ) FW-004