1 CODE: 1524 2 3 4 IN THE FAMILY DIVISION 5 OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 6 IN AND FOR THE COUNTY OF WASHOE 7 8 In the Matter of Case No. 9 and Dept. No. 10 11 Joint Petitioners 12 ________________________________/ 13 JOINT DECLARATION IN SUPPORT OF FEE WAIVER 14 The undersigned attorney or staff person of the Family Court Self-Help Center certifies 15 that the Petitioners qualify to have their fees waived pursuant to NRS 12.015. 16 This Declaration is based on information provided by the litigants as follows: That first Petitioners household consists of persons and their total gross income is 17 $ per (week, month, year) . 18 That second Petitioners household consists of persons and their total gross income is 19 $ per (week, month, year) . That, although the gross income exceeds the guidelines for waiver, there are extenuating 20 circumstances to be considered, which are: 21 22 We declare under penalty of perjury that Date: 23 the information provided is true to the 24 best of our knowledge: 25 Signature:___________________________ 26 Address: ________________________ 27 A ttorney and Bar# Signature:____________________________ Family Court Self-Help Center 28 Address: Ct. App. 7/99 1 American LegalNet, Inc. www.USCourtForms.com