THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) APPLICATION FOR WAIVING FEE Check one: Filing fee Default fee Citation fee 1. 2. 3. 4. Person requesting that fee be waived Document being filed Amount of fee to be waived $ Reasons for request to waive fee: For the above-stated reasons, I request that the fee specified above be waived. Date Signature of person making request ORDER Fee is waived. Fee is not waived. Date Judge NHJB-2314-P (10/01/2006) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com