Order on Court Fee Waiver (Superior Court)
Clerk stamps date here when form is filed.
Person who asked the court to waive court fees: Name: Street or mailing address: City: State: Zip:
Lawyer, if person in 1 has one (name, address, phone number, e-mail, and State Bar number):
Fill in court name and street address:
Superior Court of California, County of
A request to waive court fees was filed on (date): The court made a previous fee waiver order in this case on (date):
Fill in case number and case name: Case Number: Case Name:
Read this form carefully. All checked boxes
are court orders.
Notice: The court may order you to answer questions about your finances and later order you to pay back the waived fees. If this happens and you do not pay, the court can make you pay the fees and also charge you collection fees. If the