Fill and Sign the Waiver Fees Costs Form

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) : TELEPHONE NO.: ––––– ––––– ––––– ––––– ––––– ATTORNEY FOR (Name) : ––––– FOR COURT USE ONLY NAME OF COURT, JUDICIAL DISTRICT OR BRANCH COURT, IF ANY STREET ADDRESS: ––––– MAILING ADDRESS : ––––– CITY AND ZIP CODE: ––––– PLAINTIFF: ––––– FW-002 ––––– DEFENDANT: ––––– APPLICATION FOR WAIVER OF ADDITIONAL COURT FEES AND COSTS CASE NUMBER: ––––– 1. I was granted a waiver of court fees and costs on (date): ––––– 2. a. My financial status has not changed since I filed my original application. b. My financial status has changed since I filed my original application AND a new application is attached. 3. I ask the court to extend by waiver of fees to cover the following additional court fees and costs: a. Jury fees and expenses. b. Court appointed interpreters' fees for witnesses. c. Witness fees of peace officers whose attendance is necessary for reasons shown below. d. Reporters' fees for attendance at hearings and trials held more than sixty days after the date of the original application as shown above. e. Witness fees for court appointed experts. f. Other (specify): ––––– ––––– ––––– ––––– ––––– 4. These additional services are needed because (use additional sheet if necessary) : ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on (date): ––––– at (place): ––––– ––––– 4 (Type or print name) (Signature) Form Adopted for mandatory use Judicial Council of California FW-002 [Rev. January 1, 2007] APPLICATION FOR WAIVER OF ADDITIONAL COURT FEES AND COSTS (IN FORMA PAUPERIS) Government Code § 68511.3 Electronic form © 1997-2007 www.lawca.com