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Request to Waive Court Fees
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 Kern
your fees will have a lien on any such settlement in the amount of the Kern County Superior Court
waived fees and costs. The court may also charge you any collection costs. 1215 Truxtun Ave
Bakersfield CA 93301
@ Your Information (person asking the court to waive the fees):
Name: Maria Isabel Trujillo
Street or mailing address: 105 Eastern Ave. Fill in case number and name:
City: Taft State: CA __ Zip: 93268 Case Number:
Phone: (661) 770-9327
@ Your Job, if you have one (job title): Unemployed
Name of employer:
Case Name:
Employer’s address: CA
@ Your Lawyer, if you have one (name, firm or affiliation, address, phone number, and State Bar number).
Rebeca Gonzalez, Rebeca Gonzalez Attorney at Law APC 329149
5330 Office Centre Ct., Suite 32, Bakersfield, CA 93309
a. The lawyer has agreed to advance all or a portion of your fees or costs (check one): Yes No
b. (If ves, your lawyer must sign here) Lawyer's signature:
If your 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?
O).)
M Superior Court (See Information Sheet on Waiver of Superior Court Fees and Costs (form FW-001-INF
C1 Supreme Court, Court of Appeal, or Appellate Division of Superior Court (See Information Sheet on Waiver of
Appellate Court Fees (form APP-015/FW-015-INFO).)
Why are you asking the court to waive your court fees?
a. MI I receive (check all that apply; see form FW-001-INFO for definitions):
[1 Food Stamps] Supp. Sec. Inc. [] SSP MW] Medi-Cal [] County Relief/Gen. Assist. [] IHSS
(2 CalWORKS or Tribal TANF OO CAPI Of wic (1 Unemployment
b. £1 My gross monthly household income (before deductions for taxes) is less than the amount listed below. (If
you check 5b, you must fill out 8, and 9 on page 2 of this form.)
Family Size | Family Income | Family Size | Family Income | Family Size | Family Income | //more than 6 people
3 5 $6,096.67 at home, add $896.67
1 $2,510.00 | $4,303.34
4 6 ‘for each extra person.
2 $3,406.67 | |
$5,200.00 $6,993.34
c. MW) Ido 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):
M waive all court fees and costs CD waive some of the court fees (7 let me make payments over time
@®a Check here if you asked the court to waive your court fees for this case in the last six months.
(Uf your previous request is reasonably available, please attach 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.
Date: 4/23/2024
_|Maria Isabel Trujillo
v
Pra
Sign here
aia Trvsiio
Print your name here
‘Judicial Council of California, wav courts.ca. gov Request to Waive Court Fees FW-001, Page 1 of 2
Rev. Apri 1, 2024, Mandatory Form
Government Code, § 68633; =
Cal, Rules of Court, rules 3.51, 8.26, and 8.818
Case Number:
Your name: Maria Isabel Trujillo
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.
@ Check here if your income changes a lot from month to month.
If it does, complete the form based on your average income for
(ov ur Money and Property
Cash s
the past 12 months, b. Allfinancial accounts (List bank name and amount):
Your Gross Monthly Income mH $
a. List the source and amount of any income you get each month, @ $s.
including: wages or other income from work before deductions, @) $
‘spousal/child support, retirement, social security, disability, 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 / Year Value ‘Still Owe
net business or rental income, reimbursement for Job-related a) S$ $.
expenses, gambling or lottery winnings, etc. $ 8.
Q)
Q 8) 8. $.
@) Real estate Fair Market How Much You
@) Address Value ‘Still Owe
@) a § S$
b. Your total monthly Income: (2) S$ $.
lousehold Income
e. Other personal property (jewelry, furniture, furs,
stocks, bonds, atc):
a. List the income of all other persons living in your home who Fair Market How Much You
depend in whole or in part on you for support, or on whom you Describe Value ‘Still Owe
depend in whole or in part for support. a &
Gross Monthly (2) $. §.
Name Age Relationship Income
(1). Your Monthly Deductions and Expenses
2) — & a List any payroll deductions and the monthly amount below:
@). — % a) &
4). — $ @) 8.
b. Total monthly Income of persons above: $ @) §
@ $
Total monthly income and
household income (8b plus 9b): $, Rent or house payment & maintenance
Food and household supplies
qd Utilities and telephone
Clothing
Laundry and cleaning
Medical and dental expenses
Insurance (life, health, accident, etc.)
‘School, child care
Child, spousal support (another marriage)
Transportation, gas, aulo repair and insurance
Installment payments (list each befow):
Paid to;
(i)
@
@)
To list any other facts you want the court to know, such as
‘Wages/earings withheld by court order
unusual medical expenses, etc., attach form MC-025 or
attach a sheet of paper and write Financial Information and n Any other monthly expenses (list each below).
Paid to: How Much?
your name and case number at the top.
Check here if you attach another page. |_| @ 8.
@ $
Important! Wf your financial situation or ability to pay @) 8.
court fees improves, you must notify the court within five
Total monthly expenses (add 17a—71n above): $.
days on form FW-010.
Rev. April 1, 2024 Request to Waive Court Fees FW-001, Page 2 of 2
Preview
Request to Waive Court Fees 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 Kern your fees will have a lien on any such settlement in the amount of the Kern County Superior Court waived fees and costs. The court may also charge you any collection costs. 1215 Truxtun Ave Bakersfield CA 93301 @ Your Information (person asking the court to waive the fees): Name: Maria Isabel Trujillo Street or mailing address: 105 Eastern Ave. Fill in case number and name: City: Taft State: CA __ Zip: 93268 Case Number: Phone: (661) 770-9327 @ Your Job, if you have one (job title): Unemployed Name of employer: Case Name: Employer’s address: CA @ Your Lawyer, if you have one (name, firm or affiliation, address, phone number, and State Bar number). Rebeca Gonzalez, Rebeca Gonzalez Attorney at Law APC 329149 5330 Office Centre Ct., Suite 32, Bakersfield, CA 93309 a. The lawyer has agreed to advance all or a portion of your fees or costs (check one): Yes No b. (If ves, your lawyer must sign here) Lawyer's signature: If your 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? O).) M Superior Court (See Information Sheet on Waiver of Superior Court Fees and Costs (form FW-001-INF C1 Supreme Court, Court of Appeal, or Appellate Division of Superior Court (See Information Sheet on Waiver of Appellate Court Fees (form APP-015/FW-015-INFO).) Why are you asking the court to waive your court fees? a. MI I receive (check all that apply; see form FW-001-INFO for definitions): [1 Food Stamps] Supp. Sec. Inc. [] SSP MW] Medi-Cal [] County Relief/Gen. Assist. [] IHSS (2 CalWORKS or Tribal TANF OO CAPI Of wic (1 Unemployment b. £1 My gross monthly household income (before deductions for taxes) is less than the amount listed below. (If you check 5b, you must fill out 8, and 9 on page 2 of this form.) Family Size | Family Income | Family Size | Family Income | Family Size | Family Income | //more than 6 people 3 5 $6,096.67 at home, add $896.67 1 $2,510.00 | $4,303.34 4 6 ‘for each extra person. 2 $3,406.67 | | $5,200.00 $6,993.34 c. MW) Ido 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): M waive all court fees and costs CD waive some of the court fees (7 let me make payments over time @®a Check here if you asked the court to waive your court fees for this case in the last six months. (Uf your previous request is reasonably available, please attach 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. Date: 4/23/2024 _|Maria Isabel Trujillo v Pra Sign here aia Trvsiio Print your name here ‘Judicial Council of California, wav courts.ca. gov Request to Waive Court Fees FW-001, Page 1 of 2 Rev. Apri 1, 2024, Mandatory Form Government Code, § 68633; = Cal, Rules of Court, rules 3.51, 8.26, and 8.818 Case Number: Your name: Maria Isabel Trujillo 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. @ Check here if your income changes a lot from month to month. If it does, complete the form based on your average income for (ov ur Money and Property Cash s the past 12 months, b. Allfinancial accounts (List bank name and amount): Your Gross Monthly Income mH $ a. List the source and amount of any income you get each month, @ $s. including: wages or other income from work before deductions, @) $ ‘spousal/child support, retirement, social security, disability, 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 / Year Value ‘Still Owe net business or rental income, reimbursement for Job-related a) S$ $. expenses, gambling or lottery winnings, etc. $ 8. Q) Q 8) 8. $. @) Real estate Fair Market How Much You @) Address Value ‘Still Owe @) a § S$ b. Your total monthly Income: (2) S$ $. lousehold Income e. Other personal property (jewelry, furniture, furs, stocks, bonds, atc): a. List the income of all other persons living in your home who Fair Market How Much You depend in whole or in part on you for support, or on whom you Describe Value ‘Still Owe depend in whole or in part for support. a & Gross Monthly (2) $. §. Name Age Relationship Income (1). Your Monthly Deductions and Expenses 2) — & a List any payroll deductions and the monthly amount below: @). — % a) & 4). — $ @) 8. b. Total monthly Income of persons above: $ @) § @ $ Total monthly income and household income (8b plus 9b): $, Rent or house payment & maintenance Food and household supplies qd Utilities and telephone Clothing Laundry and cleaning Medical and dental expenses Insurance (life, health, accident, etc.) ‘School, child care Child, spousal support (another marriage) Transportation, gas, aulo repair and insurance Installment payments (list each befow): Paid to; (i) @ @) To list any other facts you want the court to know, such as ‘Wages/earings withheld by court order unusual medical expenses, etc., attach form MC-025 or attach a sheet of paper and write Financial Information and n Any other monthly expenses (list each below). Paid to: How Much? your name and case number at the top. Check here if you attach another page. |_| @ 8. @ $ Important! Wf your financial situation or ability to pay @) 8. court fees improves, you must notify the court within five Total monthly expenses (add 17a—71n above): $. days on form FW-010. Rev. April 1, 2024 Request to Waive Court Fees FW-001, Page 2 of 2