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IN THE ____________ COURT OF ____________ COUNTY, WEST VIRGINIA
_________________________
Plaintiff or Petitioner
v. Case No. ____________
_________________________
Defendant or Respondent
ORDER:
TO FILE NEW FINANCIAL AFFIDAVIT AND
APPLICATION FOR WAIVER OF FEES, COSTS, OR SECURITY
This court hereby ORDERS ________________________________________
(name of party)
to file a new financial affidavit and application for determination by this court as to
eligibility for waiver of fees, costs, or security attendant to proceedings and services in this
case. __________________________________________ shall not be eligible for such
(name of party)
waiver until a further order of this court grants his or her new application.
ENTER, this __________ day of ______________________________.
________________________________
Circuit Judge/Family Court Judge/Magistrate
SCA-C&M204.03