STATE OF HAWAI`I
FAMILY COURT FIFTH CIRCUIT
REQUEST FOR WAIVER OF PREPAYMENT OF COURT COSTS
CASE NUMBER FCNO. -
This document is prepared by:
VS.
PLAINTIFF/PETITIONER,
Name: Address:
DEFENDANT/RESPONDENT.
Telephone No. (
) -
-
I, the above-named Plaintiff/Petitioner, swear under penalty of perjury that I do not have the resources or income to pay the costs of this matter and request that prepayment of the costs be waived.
DATE
PLAINTIFF/PETITIONER'S SIGNATURE
Reprographics (10/08)
REQUEST FOR WAIVER OF PREPAYMENT OF COURT COSTS 5F-P-167
CLEAR FORM