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Motion For Waiver Or Deferral Of Filing Fees Form. This is a Oregon form and can be use in Court Of Appeals Appellate.
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Tags: Motion For Waiver Or Deferral Of Filing Fees, Oregon Appellate, Court Of Appeals
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
IN THE COURT OF APPEALS OF THE
STATE OF OREGON :
Calendar No.
-against-
)
)
)
)
)
)
)
)
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APPELLATE CASE NO.
Plaintiff(s)
:
JUDICIAL SUBPOENA
MOTION FOR WAIVER OR DEFERRAL
:
OF FILING FEES
:
STATEMENT OF ASSETS AND LIABILITIES
:
MOTION
Defendant(s)
:
. . . . . . PETITIONER, . . . . . . . . . . . . (CROSS . . . . . . . . . . . . . . . . .
APPELLANT, . . . . . . . . . . . .RESPONDENT, . . . . . . . OUT NONAPPLICABLE WORDS) MOVES THE COURT FOR WAIVER
OR DEFERRAL OF FILING FEE IN THE ABOVE CASE.
I, THE UNDERSIGNED, SAY THAT THE FOLLOWING INFORMATION IS TRUE, AND I ASK THE COURT TO USE THE
INFORMATION TO DECIDE WHETHER I CAN HAVE A WAIVER OR DEFERRAL OF THE FILING FEE. I UNDERSTAND THAT
THE TELL THE TRUTH, I CAN OF NEW YORK
IF I DO NOTPEOPLE OF THE STATE BE CHARGED WITH UNSWORN FALSIFICATION. SEE ORS 162.085.
IN
TO THE EVENT THAT ANY PORTION OF THE FILING FEE REMAINS UNPAID AT THE TIME OF FINAL WRITTEN
DISPOSITION OF THIS CASE, THE COURT MAY SEEK ENTRY OF JUDGMENT AGAINST YOU FOR THE UNPAID
PORTION OF THE FILING FEE. SEE ORS 21.605.
1.
FULL NAME (PLEASE PRINT)
GREETINGS:
ADDRESS
CITY
2.
3.
4.
5.
6.
STATE
ZIP
“
“
“
NAMES, ADDRESSES, AGES AND RELATIONSHIP OF DEPENDENTS OTHER THAN SPOUSE:
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
LAST OR CURRENT EMPLOYER:
result of your failure to comply.
ADDRESS:
MONTHLY GROSS PAY:
Witness, Honorable
NOW EMPLOYED:
Court in
County, YES day of
“
“ NO
, one of the Justices of the
, 20
IF MARRIED, YOUR SPOUSE'S LAST OR CURRENT EMPLOYER:
ADDRESS:
HOW LONG EMPLOYED:
NOW EMPLOYED:
8.
“
“
“
HOW LONG EMPLOYED:
7.
PHONE
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
1
BIRTH DATE
/
/
SSN
MALE
FEMALE
,
the Honorable
at the
Court
located at
County of
MARRIED , on the
SINGLE
SEPARATED, at
DIVORCED
in room
day of
, 20
o'clock in the
noon, and at any recessed
orNAME ANDdate, to testify and give evidence as a witness in this action on the part of the
adjourned ADDRESS OF SPOUSE OR NEAREST RELATIVE:
“ YES
(Attorney must sign above and type name below)
MONTHLY GROSS PAY:
“ NO
Attorney(s) for
LIST ALL SOURCES OF MONEY BESIDES EMPLOYMENT PAY FOR YOU AND YOUR SPOUSE. FOR EXAMPLE:
SOCIAL SECURITY, UNEMPLOYMENT COMPENSATION, RETIREMENT BENEFITS, WORKERS' COMPENSATION,
WELFARE.
Office and P.O. Address
Telephone No.:
Facsimile No.:
1
E-Mail Address:
Although it may assist the court in verifying the information you are submitting in support of the motion, you cannot be required to
Mobile Tel. No.:
provide your social security number.
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COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
9.
REAL ESTATE OWNED BY YOU AND YOUR SPOUSE:
ADDRESS
WHAT IS IT WORTH
Index No.
:AMOUNT YOU No. ON PROPERTY
Calendar OWE
:
JUDICIAL SUBPOENA
AUTOMOBILES AND OTHER MOTOR VEHICLES OWNED BY YOU AND YOUR SPOUSE:
Plaintiff(s)
VEHICLE:
VEHICLE:
-against:
WHAT IS IT WORTH:
WHAT IS IT WORTH:
AMOUNT YOU OWE:
AMOUNT YOU OWE:
:
BANK OR SAVINGS ACCOUNT, INCLUDING CREDIT UNIONS, OWNED BY YOU AND SPOUSE:
:
10.
11.
ALL OTHER PROPERTY OR ASSETS EXCEEDING $200 IN VALUE. FOR EXAMPLE, FURNITURE, STOCKS, BONDS,
Defendant(s)
:
. .BOATS, .RV'S, TRAILERS,.CAMPERS,. GUNS . . . . .JEWELRY.. . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AND . . . . . . . .
DESCRIPTION:
VALUE:
DESCRIPTION:
VALUE:
MONEY OWED TO YOU OR SPOUSE BY OTHERS:
THE PEOPLE OF THE STATE OF NEW YORK
NAME OF DEBTOR:
AMOUNT OWED:
MONTHLY EXPENSES:
TO
RENT/HOUSE PMT:
$
DEPARTMENT STORES:
$
FOOD:
$
DOCTORS/MEDICAL:
$
UTILITIES:
$
:
$
GREETINGS:
CAR PAYMENT:
$
:
$
“
“
WE COMMAND YOU, that YES
all business andNO
excuses being laid aside, you and each of you attend before
I RECEIVE FOOD STAMPS:
,
the Honorable
at the
Court
IF YES, CURRENT ELIGIBILITY AMOUNT:
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
DATE:
SIGNATURE:
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued forOFmaximum penalty of $50 and all damages sustained as a
CERTIFICATE a SERVICE
result of your failure to comply.
I CERTIFY THAT I SERVED A COPY OF THIS MOTION AND AFFIDAVIT FOR WAIVER OR DEFERRAL OF FILING FEE ON:
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(NAME OF OPPOSING PARTY)
(ADDRESS OF OPPOSING PARTY)
(NAME OF OPPOSING PARTY)
(ADDRESS OF OPPOSING PARTY)
DATE:
SIGNATURE:
(Attorney must sign above and type name below)
Attorney(s) for
R:\Shared Folders\Team1\Pro Se Packets\Motion to Waive Fees.wpd
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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