Fillable Usually, you must pay a fee to file (Family Law Self Help Center)

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Many family law matters involve complex and valuable legal rights which cannot adequately be protected without the assistance of an
attorney. The information provided is basic, general information that does not fit all situations. It is the duty of each self-represented
individual to know what rules of court and law apply. For more information on the law, these forms, and free classes, visit
www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road.
Purpose:
Usually, you must pay a fee to file court papers. If you cannot afford the fee, you can apply to waive
it.
What Do I Have to Show to Get a Fee Waiver?
There is no sure way to get a fee waiver approved. Each case is different, and the judge will look at
your total financial situation to decide if you qualify. This process is for the truly needy – those who
would not be able to file their papers without a fee waiver.
How Long Will It Take?
Because so many requests are submitted, it can take 3-4 weeks before you will find out the judge’s
decision.
Can I Pay Now and Get a Refund Later if My Application is Approved?
No. Once a fee is paid to the Court, it will not be refunded.
How Long Does It Last?
If approved, your fee waiver will waive your filing fees for one year. If you need fees waived after
that, you will have to reapply.
Use black ink and write clearly.
Application to Proceed in Forma Pauperis – One for Each Spouse
This form tells the judge about your employment, your income, your expenses, and your assets.
There are 2 applications in this packet, because BOTH SPOUSES MUST COMPLETE AN
APPLICATION. Fill out every section.
Order to Proceed in Forma Pauperis
Fill out as much of this form as you can. The judge will sign the Order if approved.
The Legal Paperwork You Want to File
Complete the documents from the Joint Petition Packet. You have to submit that paperwork along
with your request to waive the fees so the judge knows what you are trying to file.
© Clark County Self-Help Center Fee Waiver Application
Rev. Nov. 2015 ALL RIGHTS RESERVED
1
PIFP
Name: _________________________
Address: _______________________
City, State, Zip: __________________
Phone: _________________________
Email: _________________________
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
_
_____________________________
Joint Petitioner,
and
_
_____________________________
Joint Petitioner.
CASE NO.: ____________________
DEPT: ____________________
Application to Proceed in Forma Pauperis
Pursuant to NRS 12.015, and based upon the information contained in this Application
and Affidavit, I request permission from this Court to proceed without paying filing fees, or
other costs and fees as provided in NRS 12.015 because I lack sufficient financial ability.
I understand that if approved, the order allowing me to proceed in forma pauperis will
be valid for one year. I will be required to file a new Application to Proceed in Forma
Pauperis if I need further filing fees and court costs and fees waived after one year.
EMPLOYMENT: ( check one)
I am unemployed.
I am employed. My employer is and my job
title is .
I am self-employed. The name of my business is .
© Clark County Self-Help Center Fee Waiver Application
Rev. Nov. 2015 ALL RIGHTS RESERVED
2
Personal Income (write “0” for any income you do not have)
A Monthly Wages from Employment (before taxes) $
B Monthly Tip Income $
C Monthly Unemployment Benefits $
D
Public Benefits/Assistance received each month
□ TANF □ SSD □ SSI □ food stamps □ other: __________
$
E Social Security $
F Retirement / Pension $
G Monthly Child Support received $
H Other: _____________________________________ $
TOTAL INCOME (add lines A-H) $
Household Information
A How many adults (18 and up) live in the home (include yourself)?
B How many children (under 18) live with you?
TOTAL HOUSEHOLD SIZE (add A+B)
Household Income
List the names of the adults you live with and their estimated monthly earnings:
Name: Relationship: $
Name: Relationship: $
Name: Relationship: $
Monthly Expenses (write “0” for any expense you do not have)
A Rent / Mortgage $
B Utilities (electricity, gas, phone, other utilities) $
C Food $
D Child Care $
E Medical Expenses (including health insurance) $
F Transportation (insurance, gas, bus fare, etc.) $
G Other: _____________________ $
TOTAL EXPENSES (add lines A-G) $
© Clark County Self-Help Center Fee Waiver Application
Rev. Nov. 2015 ALL RIGHTS RESERVED
3
Assets (write “n/a” and “0” for any assets you do not have)
Asset What It’s Worth What you Owe
Checking Account
$ n/a
Savings Account
$ n/a
Car (year/make/model: )
$ $
House / Real Estate You Own
(address: )
$ $
Other:
$ $
CREDIT CARDS.
Do you have a credit card that you can use to charge the filing fee?
No Yes Yes, but my current balance is $___________
Declaration in
Support
of Request to
P
r
ocee
d
In Forma Pauperis
Briefly explain your current financial situation and why you are unable to pay the filing fee
.
For example, if you are unemployed explain why, for how long, and what efforts you are
making to obtain employment. If you are temporarily living with a friend or relative explain
for how long and how they help you financially.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
I declare under penalty of perjury under the law of the State of Nevada that the foregoing is
true and correct.
_______________ _______________________ _______________________
Date Printed Name Signature
/s/
© Clark County Self-Help Center Fee Waiver Application
Rev. Nov. 2015 ALL RIGHTS RESERVED
1
PIFP
Name: _________________________
Address: _______________________
City, State, Zip: __________________
Phone: _________________________
Email: _________________________
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
_
_____________________________
Joint Petitioner,
and
_
_____________________________
Joint Petitioner.
CASE NO.: ____________________
DEPT: ____________________
Application to Proceed in Forma Pauperis
Pursuant to NRS 12.015, and based upon the information contained in this Application
and Affidavit, I request permission from this Court to proceed without paying filing fees, or
other costs and fees as provided in NRS 12.015 because I lack sufficient financial ability.
I understand that if approved, the order allowing me to proceed in forma pauperis will
be valid for one year. I will be required to file a new Application to Proceed in Forma
Pauperis if I need further filing fees and court costs and fees waived after one year.
EMPLOYMENT: ( check one)
I am unemployed.
I am employed. My employer is and my job
title is .
I am self-employed. The name of my business is .
© Clark County Self-Help Center Fee Waiver Application
Rev. Nov. 2015 ALL RIGHTS RESERVED
2
Personal Income (write “0” for any income you do not have)
A Monthly Wages from Employment (before taxes) $
B Monthly Tip Income $
C Monthly Unemployment Benefits $
D
Public Benefits/Assistance received each month
□ TANF □ SSD □ SSI □ food stamps □ other: __________
$
E Social Security $
F Retirement / Pension $
G Monthly Child Support received $
H Other: _____________________________________ $
TOTAL INCOME (add lines A-H) $
Household Information
A How many adults (18 and up) live in the home (include yourself)?
B How many children (under 18) live with you?
TOTAL HOUSEHOLD SIZE (add A+B)
Household Income
List the names of the adults you live with and their estimated monthly earnings:
Name: Relationship: $
Name: Relationship: $
Name: Relationship: $
Monthly Expenses (write “0” for any expense you do not have)
A Rent / Mortgage $
B Utilities (electricity, gas, phone, other utilities) $
C Food $
D Child Care $
E Medical Expenses (including health insurance) $
F Transportation (insurance, gas, bus fare, etc.) $
G Other: _____________________ $
TOTAL EXPENSES (add lines A-G) $
© Clark County Self-Help Center Fee Waiver Application
Rev. Nov. 2015 ALL RIGHTS RESERVED
3
Assets (write “n/a” and “0” for any assets you do not have)
Asset What It’s Worth What you Owe
Checking Account
$ n/a
Savings Account
$ n/a
Car (year/make/model: )
$ $
House / Real Estate You Own
(address: )
$ $
Other:
$ $
CREDIT CARDS.
Do you have a credit card that you can use to charge the filing fee?
No Yes Yes, but my current balance is $___________
Declaration in
Support
of Request to
P
r
ocee
d
In Forma Pauperis
Briefly explain your current financial situation and why you are unable to pay the filing fee
.
For example, if you are unemployed explain why, for how long, and what efforts you are
making to obtain employment. If you are temporarily living with a friend or relative explain
for how long and how they help you financially.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
I declare under penalty of perjury under the law of the State of Nevada that the foregoing is
true and correct.
_______________ _______________________ _______________________
Date Printed Name Signature
/s/
© Clark County Self-Help Center Fee Waiver Order
Rev. Nov. 2015 ALL RIGHTS RESERVED
1
OIFP
Name: _________________________
Address: _______________________
City, State, Zip: __________________
Phone: _________________________
Email: _________________________
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
_
_____________________________
Joint Petitioner,
and
_
_____________________________
Joint Petitioner.
CASE NO.: ____________________
DEPT: ____________________
Order to Proceed in Forma Pauperis
Upon consideration of the Joint Petitioners’ Applications to Proceed in Forma
Pauperis, and it appearing that there is not sufficient income, property, or resources with which
to maintain the action, and good cause appearing therefore:
IT IS HEREBY ORDERED that (name) __________________________________
and (name) __________________________________ shall be permitted to proceed In Forma
Pauperis with this action pursuant to the terms of this Order.
IT IS FURTHER ORDERED that if the above-named party prevails in this action,
the Court shall enter an order pursuant to NRS 12.015 requiring the opposing party to pay the
Court, within five (5) days, the costs which would have been incurred by the prevailing party,
and those costs must then be paid as provided by law.
© Clark County Self-Help Center Fee Waiver Order
Rev. Nov. 2015 ALL RIGHTS RESERVED
2
IT IS FURTHER ORDERED that the above-named party shall be permitted to
commence or defend the action without costs. The Clerk of Court shall file or issue any
necessary writ, process, pleading, or paper without charge.
IT IS FURTHER ORDERED that the Sheriff or other appropriate officer within this
State shall make personal service of any necessary writ, pleading, or paper without charge.
IT IS FURTHER ORDERED that this Order shall not apply to costs for transcripts
or recordings of court proceedings. A separate application and order shall be required to waive
any such fees.
IT IS FURTHER ORDERED that this Order shall expire one year from the date the
Order is filed. The party shall be required to reapply for any further waiver after this Order
expires.
DATED this _______ day of _____________________, 20__.
___________________________________
DISTRICT COURT JUDGE
Respectfully Submitted:
(Signature) __________________________________
(Printed Name) _______________________________
In Proper Person
/s/
Mail: Send your forms to Clerk of Court, 601 N Pecos, Las Vegas, NV 89101.
Online: You can upload your documents at https://nevada.tylerhost.net/OfsWeb/. When setting up
your efiling account, you must set up a Payment Account. Select “Waiver” to avoid being
charged the filing fee. There is a $3.50 fee to e-file your documents that cannot be waived.
The Order to Proceed in Forma Pauperis should not be efiled, but it can be emailed after you
efile the ex parte motion. See Step 2 for more information.
In person: Bring your forms to the Family Courthouse. File them at the Clerk’s Office on the 1
st
floor
(you will need to get a ticket for filing when you arrive).
Add your case number and department letter on the Order to Proceed in Forma Pauperis. You can submit in
one of these ways:
Mail it to the courthouse: Mail it to: Family Court, 601 N. Pecos Rd., Las Vegas, NV 89101
Email it to your judge: Find the letter that your case is assigned to (for example, Dept C, Dept F,
etc.). Insert the department letter where the _ is in the following email format:
dept_inbox@clarkcountycourts.us and send it by email.
Bring it to the courthouse: Take it to the drop box on the first floor outside the Clerk’s Office.
The box says “Department Drop Box.”
It may take 2-3 weeks before you get an answer from the judge.
If Your Application is Approved:
The judge will sign the Order, and then the Clerk will file your documents and send it to you. Keep
the order in a safe place as you may need it later.
If There is a Problem With Your Documents:
You may have the option to fill out a new Application to have your request considered again. The
note from the judge’s staff will say if they need more information to decide if you should get the fee
waiver.
If Your Application is Denied:
You will receive your documents back with a note explaining that your application was denied. You
will have to pay the filing fee by mail, online, or in person. You may not be able to file any other
documents with the family court until the filing fee is paid.
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Completed 15 January 2021

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