Fill and Sign the Motion and Declaration for Waiver of Form

Mt and Dec l for Civil Fee Waiver (MT WV F) - Page 1 of 2 WPF GR 3 4.0100 (07/201 9) – GR 3 4 Court of Washington For Petitioner /Plaintiff, vs. Respondent /Defendant. No . ________________________ Motion and Declaration For Waiver of Civil Fee s and Surcharges (MT WV F) I. Motion 1.1 I am the [ ] petitioner/plaintiff [ ] respondent/defendant in this action. 1.2 I am asking for a waiver of fees and sur charges under GR 34. II. Basis for Motion 2.1 GR 34 allows the court to waive “ fees or surcharges the payment of which is a condition pre cedent to a litigant's ability to secure access to judicial relief ” for a person who is indigent. As outlined below, I am indigent. Dated: Signature of Requesting Party Print or Type Name III. Declaration I declare that, 3.1 I cannot afford t o meet my necessary household living expenses and pay the fees and surcharges imposed by the court. Please see the attached Financial Statement, which I incorporate as part of this declaration. 3.2 In addition to the information in the financial stateme nt, I would like the court to consider the following: Mt and Dec l for Civil Fee Waiver (MT WV F) - Page 2 of 2 WPF GR 3 4.0100 (07/201 9) – GR 3 4 . [ ] (C heck if applies .) I filed this motion by mail. I enclosed a self -addressed stamped envelope with the motion so that I can receive a copy of the order once it is signed. I declar e under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at (city) ____________ __________, (state) ________ on (date) __________________ . Signature Print or Type Name