INSTRUCTIONS FOR FEE DEFERRAL OR WAIVER APPLICATION & DECLARATION Fees and costs are required in any civil case, including dissolutions (divorce), small claims, evictions (FED ­ Forcible Entry and Detainer), and arbitration. A list of fees is available at www.courts.oregon.gov. The court accepts cash, credit and debit cards, and money orders or checks made out to the State of Oregon. If you cannot afford to pay the amount required, you may ask the court to defer or waive those fees and costs. If the court defers the fees and costs you do not need to pay them at the time of filing. You still have to pay according to the schedule set up by the court. If you want to apply for a deferral or waiver of fees, complete the following forms: The case heading must be the same as on the papers you filed or received APPLICATION & DECLARATION FOR DEFERRAL OR WAIVER OF FEES. Fill in the case heading and mark whether you are the Plaintiff/Petitioner or Defendant/Respondent. You must completely fill out the Declaration. Do not leave any sections blank. Date, sign, and print your name. This document is kept confidential (only court staff will see it, not the other party). ORDER REGARDING DEFERRAL OR WAIVER OF FEES. Fill in the case heading and mark whether you are the Plaintiff/Petitioner or Defendant/Respondent. The judge or designated court staff will complete the rest of the form. If you claim to be eligible for public assistance, you must show proof of the amount you receive from all programs. Once the forms are complete, bring them to court. You will appear before a judge or other court staff. Jackson County Court-specific instructions are attached. Tips for completing the Declaration: Complete EVERY entry ­ enter "N/A" for "Not Applicable" if it does not apply to you. ONLY enter payments that you are legally required to make for yourself or your dependents. If you are paying any expenses for a child who is not your legal dependent, a parent, or anyone else, do NOT include those payments in your Declaration. "DL/ID" is your Driver's License or identification number. "Transportation" includes bus passes, parking fees, etc. "Vehicle payments" and "Insurance" include all vehicles that you are currently making payments on (cars, trucks, motorcycles, scooters, bicycles, etc.). A contingency fee agreement means that your lawyer gets paid part of any judgment or award that you get in this case. Fee Deferral or Waiver Instructions (eForm: 11/9/12) Page 1 of 2 Public Civil Fee Waiver Deferral Instructions Jackson Case No: 12/21/12 American LegalNet, Inc. www.FormsWorkFlow.com Jackson County Circuit Court, 100 S. Oakdale, Medford, OR 97501 541-776-7171 Instructions for Fee Deferral or Waiver Applications and Declarations If you want to apply for a deferral or waiver of fees, you must complete the attached forms (Application and Declaration of Assets). ALL SPACES on the Application and Declaration must be complete. If you are receiving public assistance, proof MUST be attached to your Declaration of Assets. We will not make copies of the proof provided so if you wish to keep a copy for your records, please make a photocopy before submitting your documents to court. Acceptable proof must be dated within the same month you file these documents and includes one of the following: · · · · Food Stamps ­ computer printout of "issuance history" stamped by DHS, YOUR OREGON TRAIL CARD IS NOT ACCEPTABLE PROOF. TANF ­ computer printout of "issuance history" stamped by DHS. Oregon Health Plan (Standard, Plus, or w/Limited Drug) ­ computer printout of "issuance history" stamped by DHS. Supplemental Security & Disability Income ­ a Benefit Verification Letter from Social Security Administration that includes ALL of the following: 1. Type of claim (supplemental, disability, etc.) 2. Date benefits began 3. Monthly benefit amount Proof may be obtained at the offices below: DHS Medford 800 Cardley Ave. Medford, OR 97504 541-776-6172 DHS Ashland 1658 Ashland St. Ashland, OR 97520 541-482-2041 DHS White City 3131 Avenue C White City, OR 97503 541-864-8700 Social Security 3501 Excel Dr. # 101 Medford, OR 97504 866-931-7943 APPLICATIONS THAT ARE INCOMPLETE OR MISSING THE REQUIRED PROOF STATED ABOVE WILL RESULT IN A DENIAL OF THE FEE DEFERRAL OR WAIVER. Fee Deferral or Waiver Instructions (eForm: 11/9/12) Page 2 of 2 Public Civil Fee Waiver Deferral Instructions Jackson Case No: 12/21/12 American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF JACKSON Case No. _____________________ v. Plaintiff/Petitioner Application & Declaration for Deferral or Waiver of Fees for: Plaintiff/Petitioner Defendant/Respondent Defendant/Respondent ACCESS TO THIS DOCUMENT IS RESTRICTED TO PROTECT THE PRIVACY OF PARTIES I am asking for deferral or waiver of fees in this case because I am unable to pay all or part of the fees right now. I understand that I must complete the Declaration for Deferral or Waiver of Fees to prove to the court that I do not have enough money to pay the fees. I understand that if I do not, my request can be denied. 1. I am applying for deferral or waiver of the following fees (check ALL that apply): Filing Fees Arbitration Fee Sheriff's Service Fee Non-Jury Trial Fee Parenting Class Fee Visitor's Fee: Note: Guardianship, conservatorship and probate fees are limited to waiver or full payment; Guardianship and conservatorship cases are based on "Protected" person's information; Probate cases are based on "Deceased" person's information. 2. If the court defers fees, I understand that: a. The fees are a debt I owe to the State of Oregon, and the court may put me on a payment plan. I agree to pay the fees according to the payment plan. If I fail to do so, the total amount of unpaid fees will be referred for collection. b. The court will enter a judgment against me for the unpaid amount of the fees that are deferred, and the judgment will be enforced regardless of the outcome of the case. c. If the court refers this judgment for collection, administrative and collection costs will automatically be added to the judgment without further notice to me or further action by the court. 3. I understand that if the clerk denies my application, I have the right to ask a judge to review my application. Fee Deferral or Waiver Application and Declaration (eForm: 11/9/12) Page 1 of 4 Public Civil Fee Waiver Deferral Application Declaration Jackson Case No: 12/21/12 American LegalNet, Inc.