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: Jasmin Lynn Dominguez
           Street or mailing address: 9338 Odessa Ave
           City: North Hills                               State: CA       Zip: 91343

  2        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
                                                                                                               Los Angeles
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