FW-005 Notice: Waiver of Court Fees (Superior Court) Clerk stamps date here when form is filed. Person who asked the court to waive court fees: Name: : Mailing address: 1 City: Phone number: State Zip Lawyer, if person in 1 has one: (name, address, phone number, e-mail, and State Bar number): 2 Fill in court name and street address: Superior Court of California, County of 3 Your Request to Waive Court Fees was filed on (date): Fill in case number and case name:Number: Case Case Name: 4 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): • Filing papers • Making copies and certifying copies • Giving notice and certificates • Sheriff’s fee to give notice • Sending papers to another court department • Court-appointed interpreter in small claims court • Reporter’s daily fee (for up to 60 days after the date of this notice, at the court-approved daily rate) • Court fee for phone hearing • Preparing, certifying, copying, and sending the clerk’s transcript on appeal. Clerk, by Date: , Deputy 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. Clerk's Certificate of Service I certify that I am not involved in this case and (check one): A certificate of mailing is attached. I handed a copy of this notice to the party and attorney, if any, listed in 1 and 2 , 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 1 and 2 , from (city): , California on the date below. Date: Judicial Council of California, www.courtinfo.ca.gov Revised July 1, 2009, Mandatory Form Government Code, § 68634(f) Clerk, by Notice: Waiver of Court Fees , Deputy FW-005, Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com