Motion And Affidavit For Waiver Of Mediation Fees
Motion And Affidavit For Waiver Of Mediation Fees Form. This is a Florida form and can be use in District Courts Of Appeal Appellate Courts.
Tags: Motion And Affidavit For Waiver Of Mediation Fees, Florida Appellate Courts, District Courts Of Appeal
IN THE DISTRICT COURT OF APPEAL OF THE STATE OF FLORIDA FIFTH DISTRICT _________________________, Appellant(s), v. _________________________, Appellate Case No. 5D__________ _______________________County Case No: ____________________ Appellee(s). _____________________________/ DATE: ____________________ MOTION FOR WAIVER OF MEDIATION FEES Appellant(s) Appellee(s) _________________________________ through undersigned counsel, hereby move(s) for waiver of mediator's fees and, in support thereof, submits the attached affidavit, and would state that payment of such fees would create an undue financial burden for the following reasons: ______________________________________________________________________ ______________________________________________________________________ I hereby certify that the above information is true and correct. _______________________________ Appellant(s) Appellee(s) (Name) __________________________ (Address) _________________________ (City/State/Zip) ______________________ ________________________________ Attorney for Appellant(s) Appellee(s) (Name)________________________________ (Address)______________________________ (City/State/Zip)__________________________ NOTE: Signatures by both party and counsel are required. CERTIFICATE OF SERVICE (Counsel’s Certificate of Service that complies with Florida Rule of Appellate Procedure 9.420(d)(1) must be attached to this motion) This motion and attached affidavit should be forwarded to: Penny H. Cooper, Mediation Coordinator Fifth District Court of Appeal, 300 S. Beach St., Daytona Beach, FL 32114. Rev. 02-2007 American LegalNet, Inc. www.FormsWorkflow.com IN THE DISTRICT COURT OF APPEAL OF THE STATE OF FLORIDA FIFTH DISTRICT ______________________, Appellant(s), Appellate Case No. 5D________ _________________ County Case No: __________________ v. ______________________ Appellee(s). _____________________________/ AFFIDAVIT IN SUPPORT OF MOTION FOR WAIVER OF MEDIATION FEES I, , being first duly sworn, depose and make under oath the following statement regarding my age, marital status, dependents and financial condition. AGE: DATE OF BIRTH: MARITAL STATUS: Married DEPENDENTS: Separated Divorced Single FINANCIAL CONDITION: Affiant's Gross Income: Weekly $ Bi-Weekly $ Monthly $ Spouse's Gross Income: Weekly $ Bi-Weekly $ Monthly $ Own Home Yes No Monthly Payments $ Rent Home Yes No Monthly Rent Payment $ Value of Real Estate Owned [home, lot(s), etc.]: $ Own Automobile Value of automobile Yes No Monthly Payment $ $ Year/Make Value of Personal Property Owned (boats, stocks, jewelry, etc.) Value of Personal Debt $ $ By: Address: Signature of Affiant STATE OF FLORIDA COUNTY OF SWORN TO AND SUBSCRIBED TO BEFORE ME THIS Personally known to me Produced identification: DAY OF , 200 My Commission Expires: Notary Public, State of Florida Rev. 02-2007 American LegalNet, Inc. www.FormsWorkflow.com