Person who asked the court to waive court fees:
Name:
Mailing address:
Zip:State:City:
Phone number:
Your Request to Waive Court Fees was filed on (date):
Your request is granted by operation of law because no court action was
taken within five days after it was filed. A fee waiver is granted for the
following court fees and costs (Cal. Rules of Court, rule 3.55):
Notice: Waiver of Court Fees
Judicial Council of California, www.courts.ca.gov
Revised September 1, 2019, Mandatory Form
Government Code, § 68634(f)
FW-005, Page 1 of 1
I certify that I am not involved in this case and (check one):
Clerk's Certificate of Service
, California, on the date below.
Notice: The court may order you to answer questions about your finances and later order you to pay back the waived
fees. If this happens and you do not pay, the court can make you pay the fees and also charge you collection fees. If there
is a change in your financial circumstances during this case that increases your ability to pay fees and costs, you must
notify the trial court within five days. (Use form FW-010.) If you win your case, the trial court may order the other side
to pay the fees. If you settle your civil case for $10,000 or more, the trial court will have a lien on the settlement in the
amount of the waived fees. The trial court may not dismiss the case until the lien is paid.
Date:
, Deputy
Clerk, by
A certificate of mailing is attached.
I handed a copy of this notice to the party and attorney, if any, listed in and , at the court, on the date below.
This notice was mailed first class, postage paid, to the party and attorney, if any, at the addresses listed in and ,
from (city):
Date:
FW-005
Notice: Waiver of Court Fees
(Superior Court)
1
2
3
4
, Deputy
Clerk, by
1 2
1 2
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of California, County of
Court fills in case number when form is filed.
Case Number:
Case Name:
• Filing papers • Making copies and certifying copies
• Giving notice and certificates • Sheriff’s fee to give notice
• Sending papers to another court department • Court fee for phone hearing
• Reporter’s fee for attendance at hearing or trial, if the court is not electronically recording the proceeding and you
request that the court provide an official reporter
• Assessment for court investigations under Probate Code section 1513, 1826, or 1851
• Preparing, certifying, copying, and sending the clerk’s transcript on appeal
• Holding in trust the deposit for a reporter's transcript on appeal under rules 8.130 or 8.834
• Making a transcript or copy of an official electronic recording under rule 8.835
Lawyer, if person in
1
has one: (name, firm name, address, phone
number, e-mail, and State Bar number):
For your protection and privacy, please press the Clear
This Form button after you have printed the form.
