State of Alabama Unified Judicial System Form C-10F Page 1 Rev. 6/2019 ORDER (Section 12-19-70, Ala. Code 1975) Court Case Number IN THE COURT OF COUNTY, ALABAMA (Circuit or District) (Name of County) STYLE OF CASE: v. (Plaintiff(s)) (Defendant(s)) IT IS, THEREFORE, ORDERED AND ADJUDGED BY THE COURT AS FOLLOWS: Affiant is not indigent and the request for waiver of prepayment of docket fees is DENIED because this Court finds that the Affiant has the resources to pay the docket fees without substantial hardship as follows: The prepayment of docket fees is waived and taxed as costs at the conclusion of the case because this Court finds that payment of the docket fees will constitute a substantial hardship for the reason that the Affiant has: an income level at or below 125% of the United States poverty level as defined by the most recently revised poverty income guidelines published by the United States Department of Health and Human Services; an income level greater than 125%, but at or below 200%, of the more recently revised poverty income guidelines published by the United States Department of Health and Human Services. IT IS FURTHER ORDERED AND ADJUDGED that this Court reserves the right and may order reimbursement of docket fees. Done this . (Date) (Signature of , Judge) (Printed Name) American LegalNet, Inc. www.FormsWorkFlow.com