DETERMINATION REGARDING FEES AND COSTS _________________ ________________________________________Court Case Name and Number Name of Applicant __________________________________________________________________________ Address ______________________________________________________________________________ (Street and number) (City of Town) (State and Zip) FORTHWITH DETERMINATION BY CLERK (Register, Recorder)9 ALLOWED FORTHWITH. The applicants affidavit appears regular and complete on its face, indicates that the applicant is indigent, and requests waiver, substitution or payment by the Commonwealth of normal fees and costs only. Pursuant to G. L. c. 261, 27C(2), the application is therefore ALLOWED forthwith without hearing, and the normal fees and costs indicated in the application are: 9 waived in full 9to be paid by the Commonwealth in the amount of $ 9 REFERRED TO A JUDGE. The applicants affidavit does not satisfy all the conditions of 27C(2), and is therefore referred to a judge pursuant to 27C(3), because: 9 The affidavit is not regular and complete on its face. 9 The affidavit does not indicate that the applicant is indigent within the meaning of 27A.9 The affidavit requests waiver, substitution or payment by the Commonwealth ofextra fees and costs. Comments: Describe fees and costs waived: Date Clerk-Magistrate/ Assistant Clerk (register, recorder/assistant) X __________________________________________________________________________________________ DETERMINATION BY JUDGE 9 after hearing 9 without hearing NORMAL FEES AND COSTS 9 The application is ALLOWED with respect to the normal fees and costs indicated in the application, andthey are ordered: 9 waived in full. 9 to be paid by the Commonwealth in the amount of $ . 9 waived in part. I find that it is within the applicants limited financial means to pay a reduced amount of $ . >>>> 2 9 to be avoided by the provision of to the applicant, pursuant to 27F, as an alternative which is available at lower or no cost, is substantially equivalent and does not materially impair the rights of any party.9 The application is DENIED with respect to the normal fees and costs indicated in the application, because I find that: 9 The applicant is not indigent within the meaning of 27A. 9 Other: Describe normal fees and costs waived:EXTRA FEES AND COSTS 9 The application is ALLOWED with respect to the extra fees and costs indicated in the application, and theyare ordered: 9 waived in full. 9to be paid by the Commonwealth in the amount of $ . 9 waived in part. I find that it is within the applicants limited financial means to pay a reduced amount of $ . 9 to be avoided by the provision of to the applicant, pursuantto 27F, as an alternative which is available at lower or no cost, is substantially equivalent and does notmaterially impair the rights of any party.9 The application is DENIED with respect to the extra fees and costs indicated in the application, because I find that: 9 The applicant is not indigent within the meaning of 27A. 9 The document, service or object is not reasonably necessary to assure the applicant as effective a prosecution, defense or appeal as if the applicant were financially able to pay. 9 Other: Describe extra fees and costs waived: Date Judge X The applicant may appeal denial of this application by filing a notice of appeal with the clerk (register,recorder) of this court within 7 days from notice of denial.