APP 016 FW Order On Court Fee Waiver (Court Of Appeal Or Supreme Court) Fw016

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Order on Court Fee Waiver (Court

APP-016/FW-016 of Appeal or Supreme Court)
1 Person who asked the court to waive court fees:
Name:

Clerk stamps date here when form is filed.

To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.

Street address:
State:

City:

Zip:

Phone number:
2

Lawyer, if person in 1 has one: (Name, address, phone number, e-mail,
and State Bar number):

3

On (date):
FW-001).

4

The court reviewed your request and makes the following order:

a.

b.

you filed a Request to Waive Court Fees (form

Fill in court name and street address:

Court of Appeal or Supreme Court
Case Number:

The court grants your request and waives your court fees and costs listed below. You do not have to pay
fees for the following:
• Filing notice of appeal, petition for writ, or petition for review
Other (specify):
The court denies your request for the following reasons:
(1)
Your request is incomplete. You have 10 days from the date this notice was sent to:
• Pay your fees and costs, or
• File a new revised request that includes the items listed below (specify incomplete items):

(2)

(3)

The information you provided on the request shows that you are not eligible for the fee waiver you
requested (specify reasons):
You have 10 days from the date this notice was sent to:
• Pay your fees and costs, or
• File more information that shows you are eligible.
The court finds there is substantial question regarding your eligibility (describe issue regarding
eligibility):
You have 10 days from the date this notice was sent to:
• Pay your fees and costs, or
• File the following additional documents to support your request:

Warning! If you miss the deadline for paying your fees and costs or providing the additional items required by the
court and you are the appellant, your appeal may be dismissed.

Judicial Council of California, www.courts.ca.gov
Rev. July 1, 2010
Government Code, § 68634.5

Order on Court Fee Waiver
(Court of Appeal or Supreme Court)

APP-016/FW-016, Page 1 of 2

Court of Appeal/Supreme Court
Case Number:

Court of Appeal/
Supreme Court Case Name:

4

c.

The court needs more information. You must go to court on the date below.
Hearing
Date

_

> Date:

Dept.:

Time:

Name and address of the court if different from page 1:

Bring the following proof to support your request, if it is reasonably available:

Warning! If item 4 c. is checked and you do not go to court on your hearing date, the court will deny your
request to waive court fees and you will have 10 days to pay your fees. If you are the appellant and you do not pay
your filing fees, your appeal may be dismissed.

Date:
Signature of (check one):

Rev. July 1, 2010

Judicial Officer

Order on Court Fee Waiver

Clerk, Deputy

APP-016/FW-016, Page 2 of 2

(Court of Appeal or Supreme Court)
For your protection and privacy, please press the Clear This Form
button after you have printed the form.

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