Order on Court Fee Waiver (Superior Court)

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                                                                      Order on Court Fee Waiver                        Clerk stamps date here when form is filed.
        FW-003                              (Superior Court)
  1      Person who asked the court to waive court fees:
         Name: Michelle Sampson
         Street or mailing address: 2692 Adriatic Ave.
         City: Long Beach                   State: CA                 Zip: 90810

  2      Lawyer, if person in 1 has one (name, firm name, address,
         phone number, e-mail, and State Bar number):
                                                                                            Fill in court name and street address:
                                                                                              Superior Court of California, County of
                                                                                                          Los Angeles

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