Fillable State of Tennessee Request to Postpone Filing Fees (Sumner County Courts)

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State of Tennessee Request to Postpone Filing Fees (Sumner County Courts)

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  • 25 check-boxes
  • 92 other fields

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February 2012 (Form 3) Request to Postpone Filing Fees and Order Page 1 of 3
Approved by the Tennessee Supreme Court
I
f you think you cannot afford to pay the filing fees at this time:
• Fill out this form, and
• File it with your Request for Divorce.
Your Information:
Address:
Street Address City State Zip
Telephone Numbers:
(Home) (Work) (Cell)
Birth Date: (MM/DD/YYYY):
Dependents:
List your children below. Include your biological, adopted, step-, and foster children. Also list other
dependent relatives if they live with you for at least 6 months of the year, and who are:
• under age 19,
• under age 24 if full-time students (must live with you at least 5 months of the year), or
• any age with a permanent disability.
Name Age Relationship
Name Age Relationship
Name Age Relationship
Name Age Relationship
Name Age Relationship
State of Tennessee
Circuit Court
Sumner County
Request to Postpone
Filing Fees and Order
File No.
(Must Be Completed)
Plaintiff
(Name: First, Middle, Last) of Spouse Filing the Divorce)
Defendant
(Name: First, Middle, Last of the Other Spouse)
February 2012 (Form 3) Request to Postpone Filing Fees and Order Page 2 of 3
Approved by the Tennessee Supreme Court
Employment: If you are working now, fill out below. If you are not working now, check here:
Employer’s Name:
Employer’s Address:
Street Address
City State Zip
How much do you earn after taxes are deducted?
$ Each (Check One):
Week
Month
Other:
Other Income: List any other income that you get now or expect to get.
SOURCE OF INCOME HOW MUCH DO YOU GET? SOURCE OF INCOME HOW MUCH DO YOU GET?
AFDC
$ / month
Unemployment
$ / month
Social Security
$ / month
Worker’s Comp.
$ / month
Retirement
$ / month
Other*
$ / month
Disability
$ / month
SSI
$ / month
*Explain Sources of Other Income Here:
O
THER INCOME:
Assets: List all assets that you own separately, with your spouse, or with someone else:
ASSET TYPE:
F
AIR
M
ARKET
VALUE
M
ONEY STILL
OWED
BALANCE
$
$
$
4. Other house, condominium, land
$
L
IST ALL BANK
/
FINANCIAL ACCOUNTS BELOW
:
Bank name
Balance
1.
$
2.
$
$
Total:
$
February 2012 (Form 3) Request to Postpone Filing Fees and Order Page 3 of 3
Approved by the Tennessee Supreme Court
Other Assets:
Expenses:
How much each
month?
How much each
month?
Rent/House Payment
$
Gas
$
Phone
$
Child Care
$
Groceries
$
Court-ordered Child
Support
$
School Supplies
$
Transportation
$
Electricity
$
Medical/Dental
$
Clothing
$
Other
$
Water
$
Other
$
Debts:
1.
Who do you owe? How much do you owe?
2.
Who do you owe? How much do you owe?
3.
Who do you owe? How much do you owe?
4.
Who do you owe? How much do you owe?
5.
Who do you owe? How much do you owe?
6.
Who do you owe? How much do you owe?
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF TENNESSEE THAT:
• The information I have provided is true, correct, and complete.
• I cannot afford to pay the filing fees at this time.
Sign here: Date:
JUDGE’S ORDER:
Based on the information above and the Plaintiff’s answers (check one):
This Request is approved, and the Plaintiff may file without paying the filing fees at this time.
This Request is denied because (explain):
This Order is made on (Date): by:
(DD/MM/YYYY) Judge’s Signature
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State of Tennessee Request to Postpone Filing Fees (Sumner County Courts)

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Completed 29 July 2020

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