ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) FOR COURT USE ONLY TELEPHONE AND FAX NOS.: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MERCED STREET ADDRESS: 627 W. 21st Street CITY AND ZIP CODE: Merced, CA 95340  GUARDIANSHIP  CONSERVATORSHIP OF THE  PERSON  ESTATE  MINOR(S)  (PROPOSED) CONSERVATEE CASE NO. APPLICATION AND ORDER FOR WAIVER OF COURT INVESTIGATION FEE  GUARDIANSHIP  CONSERVATORSHIP 1. I  was  was not granted a waiver of court fees and costs in this case. If you were, on what date? ___________________ Did you complete the income and expense information on the back side of FW-001?  Yes  No If no, you must complete the reverse of this application. 2. I am not able to pay the investigation fee in this matter for the following reason(s): ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________  Check here if you need more space. Continue your explanation on a separate sheet of paper. Write “Attachment 2: Reasons for Request - continued” at the top of the paper and attach it to this form. ORDER  IT IS ORDERED that the application for waiver of Court Investigation Fee is approved  in whole  in part – PAYMENTS ALLOWED for  entire investigation fee  $ _______________.  IT IS ORDERED that the application for waiver of Court Investigation Fee is denied  in whole  in part for the following reasons (see Cal. Rules of Court, rules 3.50-3.63):  Monthly household income exceeds guidelines (Gov. Code, Section 68511.3(a)(6)(B); form FW-001INFO).  Other: ____________________________________________________________________________ DATED:  _________________________________ JUDICIAL OFFICER  Clerk, by ________________________________ DEPUTY American LegalNet, Inc. www.FormsWorkFlow.com 1. MY MONTHLY INCOME a. b. c. d. 2. My gross monthly pay is: $ ________________ My payroll deductions are: 1) _________________ $ ________________ 2) _________________ $ ________________ 3) _________________ $ ________________ 4) _________________ $ ________________ My TOTAL payroll deduction amount is $ ________________ My monthly take-home pay is (a. minus b.)………..$ ________________ Other money I get each month is (specify source and amount; include spousal support, child support, parental support, support from outside the home, scholarships, retirement or pensions, social security, disability, unemployment, military basic allowance for quarters (BAQ), veterans payments, dividends, interest or royalty, trust income, annuities, net business income, net rental income, reimbursement of job-related expenses, and net gambling or lottery winnings): 1) _________________ $ ________________ 2) _________________ $ ________________ 3) _________________ $ ________________ 4) _________________ $ ________________ The TOTAL amount of other money is……………….$ ________________ (If more space is needed, attach page labeled Attachemnt 9d.) e. MY MONTHLY INCOME IS (c. plus d.):…………………….$ ________________ f. Number of persons living in my home: ____________ Below list all the persons living in your home, including your spouse, who depend in whole or part on you for support, or on whom you depend in whole or in part for support: Name 1) 2) 3) 4) 5) The g. Age Relationship Gross Monthly Income ____________________________$___________ ____________________________$___________ ____________________________$___________ ____________________________$___________ ____________________________$___________ TOTAL amount of other money is: $___________ 3. I own or have an interest in the following property: a. Cash…………………………………..$ ________________ b. Checking, savings and credit union accounts: 1) _________________ $ ________________ 2) _________________ $ ________________ 3) _________________ $ ________________ 4) _________________ $ ________________ c. Cars, other vehicles, and boats: 1) _________________ $ ________________ 2) _________________ $ ________________ 3) _________________ $ ________________ d. Real estate: 1) _________________ $ ________________ 2) _________________ $ ________________ 3) _________________ $ ________________ e. Other personal property – jewelry, furniture, furs, stocks, bonds, etc. (list sperately): $ ________________ My monthly expenses not already listed in item 1b above are the following: a. Rent or house payment & maintenance $ _________ b. Food and household supplies $ _________ c. Utilities and telephone $ _________ d. Clothing $ _________ e. Laundry and Cleaning $ _________ f. Medical and Dental payments $ _________ g. Insurance (life, health, accident, etc) $ _________ h. School and child care $ _________ i. Child, spousal support (prior marriage) $ _________ j. Transportation and auto expenses (insurance, gas, repair) $ _________ k. Installment payments (specify purpose and amount): 1) _________________ $ ________________ 2) _________________ $ ________________ 3) _________________ $ ________________ The TOTAL amount of monthly installment payments is: $ _________ l. Amounts deducted due to wage assignments and withholding orders: $ _________ m. Other expenses (specify): 1) _________________ $ ________________ 2) _________________ $ ________________ n. MY TOTAL MONTHLY EXPENSES ARE (add a. through m.):…………………$ _______________ MY TOTAL GROSS MONTHLY HOUSEHOLD INCOME IS (a. plus d. plus f.):…………..$ ________________ I declare under the penalty of perjury under the laws of the State of California that the forgoing is true and correct. YOU MUST ATTACH A COPY OF YOUR MOST RECENT PAY STUB THAT INCLUDES YEAR TO DATE INFORMATION AND ANY OTHER PROOF OF INCOME INDICATED ABOVE. DATE: _______________________________________________ ___________________________________________ TYPE OR PRINT NAME OF PETITIONER SIGNATURE OF PETITIONER American LegalNet, Inc. www.FormsWorkFlow.com