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Court Fee Waiver Questionnaire
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We do not share your information with any third parties. This questionnaire will take approximately five (5) to ten (10) minutes of your time. Any questions marked with an asterisk (*) require an answer to progress through the questionnaire. If you have any questions about this questionnaire, for an immediate response you may live chat us or call 888-731-1500.
Name
*
First
Last
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Name of your employer?
Employer Address?
Position or Title?
Why are you asking the court to waive your court fees (Choose one of a, b, or c)
a) I receive:
Medi-Cal
Food Stamps
SSI
SSP
County Relief/General Assistance
IHSS (In Home Supportive Services)
Cal Works or Tribal TANF (Tribal Temporary Assistance for Needy Families)
CAPI (Cash Assistance Program for Aged, Blind and Disabled)
b) My gross monthly household income (before taxes) is less than:
Family of 1: $1,196.88
Family of 2: $1,615.63
Family of 3: $2,034.38
Family of 4: $2,453.13
Family of 5: $2,871.88
Family of 6: $3,290.63
More than 6 in Family
If more than six (6) in the family, provide household income
c) I do not have enough income to pay for my household's basic needs and the court fees. I ask the court to:
Waive all court fees
Waive some of the court fees
Let me make payments over time
Have you asked the court to waive court fees in this case within the last six months?
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Yes
No
Does your income change from month to month?
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If yes, please fill out below based on your average income for the past 12 months
Yes
No
Please list your monthly income before taxes:
Please list payroll deductions and amount
Please list the source and amount of any other income you receive each month, including spousal/child support, retirement, social security, etc.
Please list all other persons living in your home and their income:
*
(List only spouse and all individuals who depend in whole or in part on your support or on whom you depend in whole or in part for support)
Your Money and Property:
a) Cash
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b) All financial accounts (List bank name and amount only)
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c) Cars, boats and other vehicles (List make/year, fair market value, how much you still owe)
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d) Real Estate (List address, fair market value, how much you still owe)
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e) Other personal property (Jewelry, furniture, furs, stocks, bonds, etc.)
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Your Monthly Expenses (Do not include payroll deductions you already listed):
a) Rent or house payment & maintenance
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b) Food and household supplies
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c) Utilities and telephone
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d) Clothing
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e) Laundry and cleaning
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f) Medical and dental expenses
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g) Insurance (life, health, accident, etc.)
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h) School, child care
i) Child, spousal support
j) Transportation, gas, auto repair and insurance
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k) List installment payments below (Paid to? and how much?)
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l) Wages/earnings withheld by court order
m) Please list any other monthly expenses below (Paid to? and how much?)
YOU ARE ALMOST DONE, click submit, wait a second, and electronically initial and sign the agreement to complete the process. Thank you for choosing Superior Court Docs.
We charge $175.00 to prepare all of the judicial council documents relating to court fee waivers.
Court Fee Waiver
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Court Fee Waiver