Bear River Band Tribal Court
1. Your Information
State: ZIP:
Name:
Mailing Address:
City:
Phone Number:
2. Why are you asking the court to waive your court fees?
a.
I am currently receiving
public benefits (Food Stamps,
TANF, G
eneral Assistance, Medi-Cal,
o
r other).
b. My household income is less than the current federal
poverty guidelines.
c. I do not have enough income to pay for my
household’s basic needs and the court fees. Attach
form FL-150 Income and Expense Declaration.
Attachments:
I declare under penalty of perjury that the foregoing is true and correct.
1.
2.
The court grants your request. You do not need to
pay the court fees associated with the Court File
Number and Case Name listed above. You must tell the
court within five days if your finances improve or if you
become able to pay court fees during this case.
The court denies your request because of the
following reason(s):
Date Signature of Judge
Court Case Number:
Case Name:
(date) (Signature of Requestor)
_______________________________________________________________________________________________________
ORDER REGARDING WAIVER OF FEES
(For Court Personnel Only)
(For Court Personnel Only)
ORDER RE: FEE WAIVER
THIS IS A COURT ORDER
click to sign
signature
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click to sign
signature
click to edit
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