Preview
DocuSign Envelope ID:C42D54A4-E4F1-4FD7-81DO-A7688COFDD48
i F -001 ~ Request to Waive Court Fees ~ KKe] I0
kx Ie] 0 kx I I F~1% ~
Clerk stamps date here when form is filed.
If you are getting public benefits, are a low-income person, or do not have
enough income to pay for your household's basic needs and your court fees, you
may use this form to ask the court to waive your court fees. The court may order
you to answer questions about your finances. If the court waives the fees, you
may still have to pay later if:
~ You cannot
give the court proof of your eligibility, Fill in court name and street address
~
Your financial situation improves during this case, or Superior Court of California, County of
~ You settle
your civil case for $ 10,000 or more. The trial court that waives Kem
your fees will have a lien on any such settlement in the amount of the 1415 Truxtun Ave
waived fees and costs. The court may also charge you any collection costs.
Bakersfield, CA 93301
Your Information (person asking the court to waive the fees):
Q Name: Leticia Monie
Slxeet or mailing address: c/oRobert Doble, 3055 Wilshire Blvd., ¹ 600, LA, CA 90010,~
City; Los Angeles State. ca Zip 90010 .
)c N b
Phone number; 213 570 5396
Your Job, if you have one
Q Name of employer:
(Ioh
Leticia Monie
title):Manager
Case Name:
Fmployer's address: 1212 Iefferson St. Bakersfield, CA 93305 USA Monje v. Rhino Auto Sales, et al.
Q3 Your Lawyer, if you have one (name, firm or a+i/tartan, address, phone number, and State Bar number):
Robert Doble, ¹ 268406, Law Office of Robert Doble, 3055 Wilshire Blvd., Suite 600, LA, CA 90010
a. The lawyer has agreed to advance all or a portion of your fees or costs (check one): Yes No a
b. (Ifyes, your lawyer must sign here) Lawyer's signature:
Ifyour lawyer is not providing legal-aid type services based on your low income, you may have to go to a
hearing to explain why you are asking the court to waive the fees.
What court's fees or costs are you asking to be waived?
Q4
x Superior Court (See Information Sheer on Waiver of Superior Court Fees and Costs (form FW-OOI-INFO).)
Supreme Court, Court of Appeal, or Appellate Division of Superior Court (See Information Sheet on Waiver
ofAppellate Court Fees (form APP-015/FW-015-INFO).)
QS
Why are you asking the court to waive your court fees?
a. x I receive (check all that apply; see form FW-00/-IIIIFO for definitions): Food Stamps Supp. Sec. Inc.
SSP x Medi-Cal County Relief/Gen. Assist. IHSS CalWORKS or Tribal TANF CAPI
b. My gross monthly household income (before deductions for taxes) is less than the amount listed below. (If
you check 5b, you must fill out 7, 8, and 9 on page 2 of thisform.)
Family Size Family Income Family Size Family Income Family Size Family Income tf more than 5peop/e
1 $ 1,256.26 3 $ 2,127.09 5 $ 2,997.92 ot honte, odd $ 435.42
2 $ 1,691.67 4 $ 2,562.51 6 $ 3,433.34 for each extra person.
c. I do not have enough income to pay for my household's basic needs and the court fees. I ask the court to:
(check one and you must fill out page 2):
waive all court fees and costs waive some of the court fees
let me make payments over time
Check here if you asked the court to waive your court fees for this case in the last six months.
Q (Ifyour previous request is reasonably available please atlach it to this form and check here)
I declare under penalty of perjury under the laws of the State of California that the information I have provided
on this form and all attachments is true and correct. Oocue d Sr.
Date: 08/20/2022
Leticia Monje
Pont yotir name here Sign here
Judtdal Councs of Caldornw, www caurfs ca sov
Revised March 1, 2017, Mandatory Form
Request to Waive Court Fees FW-001, Page 1 of 2
Covemment Cade, 8 68633
Cat Rules of Court, rules 3.51, 8.26, and 8 818
DocuSign Envelope 8): C42064A4-E4F1-4FD?-B1DO-A?688COFDD48
Case Number:
Your name: Leticja Monje
If you checked 5a on page 1, do not fill out below. If you checked 5b, fill out questions 7, 8, and 9 only.
If you checked 5c, you must fill out this entire page. If you need more space, attach form MC-025 or attach a
sheet of paper and write Financial Information and your name and case number at the top.
0 Check here if your income changes a lot from month to month
the past 12 months.
0
If it does, complete the form based on your average income for
Your Money and Property
a.
b
Cash
All
$
financial accounts (List bank name and amount):
0 Your Gross Monthly Income
a List the source and amount of any income you get each month,
including. wages or other income from work before deductions,
(1)
(2)
e)
$
$
$
spousal/child support, retirement, soaal security, disability, c. Cars, boats, and other vehicles
unemployment, military basic allowance for quarters (BAQ), Fair Market How Much You
veterans payments, dividends, interest, trust income, annuities, Make 7 Year Value Still Owe
net business or rental mcome, reimbursement for lob-related (1) $ $
expenses, gambling or louery winnings, etc. (2) $ $
(1) $ e) $ $
(2) $ d. Real estate Fair Market How Much You
(2) $ Address Value Still Owe
(4) $ (1) $ $
b.Your total monthly income (2) $ $
0 Household Income
a. List the income of all other persons living in your home who
depend in whole or m part on you for support, or on whom you
e. Other personal property (jewelry, furniture, furs,
stocks, bonds, etc.)
(1)
Describe
$
Fair Market
Value
$
How Much You
Still Owe
depend in whole or in part for support
Gross Monthly (2) $ $
Name Age RelationshipIncome
(1)
(2)
(s)
$
$
0 Your Monthly Deductions and Expenses
a List any payroll deductions and the monthly amount below:
(1) $
(4) $ (2) $
b. Total monthlyincome of persons above: $ (s) $
(4) $
Total monthly income and
household income (Sb plus gb): $ b. Rent or house payment 8 maintenance $
c. Food and household supplies $
d Utilities and telephone $
e Clothmg $
f. Laundry and cleaning $
g Medical and dental expenses $
h. Insurance (life, health, acndent, etc.) $
School, child care $
j. Child, spousal support (another marriage) $
k. Transportation, gas, auto repair and insurance
$
Installment payments (list each below):
Paid to:
o) $
(2)
(8)
To list any other facts you want the court to know, such as
m. Wages/earnings withheld by court order $
unusual medical expenses, etc., attach form MC-025 or
n. Any other monthly expenses (list each below).
$
attach a sheet of paper and write Financial Information and Paid to How Much?
your name and case number at the top. (1) $
Check here ifyou attach another page.
(2) $
$
Important! If your financial situation or ability to pay (2)
court fees improves, you must notify the court within five Total monthly expenses (add 11a -11n above):
days on form FW-010.
Court Fees FW-001, Page 2 of 2
Revised March 1,
2C1 7
Request to Waive
Preview
DocuSign Envelope ID:C42D54A4-E4F1-4FD7-81DO-A7688COFDD48 i F -001 ~ Request to Waive Court Fees ~ KKe] I0 kx Ie] 0 kx I I F~1% ~ Clerk stamps date here when form is filed. If you are getting public benefits, are a low-income person, or do not have enough income to pay for your household's basic needs and your court fees, you may use this form to ask the court to waive your court fees. The court may order you to answer questions about your finances. If the court waives the fees, you may still have to pay later if: ~ You cannot give the court proof of your eligibility, Fill in court name and street address ~ Your financial situation improves during this case, or Superior Court of California, County of ~ You settle your civil case for $ 10,000 or more. The trial court that waives Kem your fees will have a lien on any such settlement in the amount of the 1415 Truxtun Ave waived fees and costs. The court may also charge you any collection costs. Bakersfield, CA 93301 Your Information (person asking the court to waive the fees): Q Name: Leticia Monie Slxeet or mailing address: c/oRobert Doble, 3055 Wilshire Blvd., ¹ 600, LA, CA 90010,~ City; Los Angeles State. ca Zip 90010 . )c N b Phone number; 213 570 5396 Your Job, if you have one Q Name of employer: (Ioh Leticia Monie title):Manager Case Name: Fmployer's address: 1212 Iefferson St. Bakersfield, CA 93305 USA Monje v. Rhino Auto Sales, et al. Q3 Your Lawyer, if you have one (name, firm or a+i/tartan, address, phone number, and State Bar number): Robert Doble, ¹ 268406, Law Office of Robert Doble, 3055 Wilshire Blvd., Suite 600, LA, CA 90010 a. The lawyer has agreed to advance all or a portion of your fees or costs (check one): Yes No a b. (Ifyes, your lawyer must sign here) Lawyer's signature: Ifyour lawyer is not providing legal-aid type services based on your low income, you may have to go to a hearing to explain why you are asking the court to waive the fees. What court's fees or costs are you asking to be waived? Q4 x Superior Court (See Information Sheer on Waiver of Superior Court Fees and Costs (form FW-OOI-INFO).) Supreme Court, Court of Appeal, or Appellate Division of Superior Court (See Information Sheet on Waiver ofAppellate Court Fees (form APP-015/FW-015-INFO).) QS Why are you asking the court to waive your court fees? a. x I receive (check all that apply; see form FW-00/-IIIIFO for definitions): Food Stamps Supp. Sec. Inc. SSP x Medi-Cal County Relief/Gen. Assist. IHSS CalWORKS or Tribal TANF CAPI b. My gross monthly household income (before deductions for taxes) is less than the amount listed below. (If you check 5b, you must fill out 7, 8, and 9 on page 2 of thisform.) Family Size Family Income Family Size Family Income Family Size Family Income tf more than 5peop/e 1 $ 1,256.26 3 $ 2,127.09 5 $ 2,997.92 ot honte, odd $ 435.42 2 $ 1,691.67 4 $ 2,562.51 6 $ 3,433.34 for each extra person. c. I do not have enough income to pay for my household's basic needs and the court fees. I ask the court to: (check one and you must fill out page 2): waive all court fees and costs waive some of the court fees let me make payments over time Check here if you asked the court to waive your court fees for this case in the last six months. Q (Ifyour previous request is reasonably available please atlach it to this form and check here) I declare under penalty of perjury under the laws of the State of California that the information I have provided on this form and all attachments is true and correct. Oocue d Sr. Date: 08/20/2022 Leticia Monje Pont yotir name here Sign here Judtdal Councs of Caldornw, www caurfs ca sov Revised March 1, 2017, Mandatory Form Request to Waive Court Fees FW-001, Page 1 of 2 Covemment Cade, 8 68633 Cat Rules of Court, rules 3.51, 8.26, and 8 818 DocuSign Envelope 8): C42064A4-E4F1-4FD?-B1DO-A?688COFDD48 Case Number: Your name: Leticja Monje If you checked 5a on page 1, do not fill out below. If you checked 5b, fill out questions 7, 8, and 9 only. If you checked 5c, you must fill out this entire page. If you need more space, attach form MC-025 or attach a sheet of paper and write Financial Information and your name and case number at the top. 0 Check here if your income changes a lot from month to month the past 12 months. 0 If it does, complete the form based on your average income for Your Money and Property a. b Cash All $ financial accounts (List bank name and amount): 0 Your Gross Monthly Income a List the source and amount of any income you get each month, including. wages or other income from work before deductions, (1) (2) e) $ $ $ spousal/child support, retirement, soaal security, disability, c. Cars, boats, and other vehicles unemployment, military basic allowance for quarters (BAQ), Fair Market How Much You veterans payments, dividends, interest, trust income, annuities, Make 7 Year Value Still Owe net business or rental mcome, reimbursement for lob-related (1) $ $ expenses, gambling or louery winnings, etc. (2) $ $ (1) $ e) $ $ (2) $ d. Real estate Fair Market How Much You (2) $ Address Value Still Owe (4) $ (1) $ $ b.Your total monthly income (2) $ $ 0 Household Income a. List the income of all other persons living in your home who depend in whole or m part on you for support, or on whom you e. Other personal property (jewelry, furniture, furs, stocks, bonds, etc.) (1) Describe $ Fair Market Value $ How Much You Still Owe depend in whole or in part for support Gross Monthly (2) $ $ Name Age RelationshipIncome (1) (2) (s) $ $ 0 Your Monthly Deductions and Expenses a List any payroll deductions and the monthly amount below: (1) $ (4) $ (2) $ b. Total monthlyincome of persons above: $ (s) $ (4) $ Total monthly income and household income (Sb plus gb): $ b. Rent or house payment 8 maintenance $ c. Food and household supplies $ d Utilities and telephone $ e Clothmg $ f. Laundry and cleaning $ g Medical and dental expenses $ h. Insurance (life, health, acndent, etc.) $ School, child care $ j. Child, spousal support (another marriage) $ k. Transportation, gas, auto repair and insurance $ Installment payments (list each below): Paid to: o) $ (2) (8) To list any other facts you want the court to know, such as m. Wages/earnings withheld by court order $ unusual medical expenses, etc., attach form MC-025 or n. Any other monthly expenses (list each below). $ attach a sheet of paper and write Financial Information and Paid to How Much? your name and case number at the top. (1) $ Check here ifyou attach another page. (2) $ $ Important! If your financial situation or ability to pay (2) court fees improves, you must notify the court within five Total monthly expenses (add 11a -11n above): days on form FW-010. Court Fees FW-001, Page 2 of 2 Revised March 1, 2C1 7 Request to Waive