IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR LINCOLN COUNTY In the Matter of ) ) __________________________________, ) 9 Co-Petitioner 9 Petitioner ) and ) ) __________________________________, ) 9 Co-Petitioner 9 Respondent ) Case No. ___________________ MOTION FOR ORDER TO WAIVE AND/ OR DEFER FEES AND COSTS; and ORDER Based on the submitted affidavit, ____ Petitioner ____ Co-Petitioner ____ Respondent requests that this court exercise its discretion under ORS 21.605 to grant an Order waiving or deferring payment of all or a portion of the filing fees and other court costs, and any Oregon sheriff’s service fees. Dated _____________, 20___. _________________________________________ Petitioner/Co-Petitioner/Respondent ORDER G All filing fees, court costs and sheriff’s service fees are waived. G _______ of the filing fees and court costs are waived. The remaining $___________ G is deferred and shall be paid in payments of $___________ per month, with the first payment due ______________ and on the same day each month until paid. G Due on filing. G Filing fees in the amount of $_________ are deferred. The fee is to be paid in payments of $ _______ per month, with the first payment due ________________ and additional payments made on the same day thereafter until paid. G ____________ of the Sheriff’s service fee is waived. The remaining amount of the service fee shall be paid to the Sheriff’s office at the time service is requested. G Other: ________________________________________________________________ G Motion is denied. Dated this ______ day of ______________, 20 _____. Submitted By: __________ Circuit Judge _____________________ _________________________________ Name _________________________________ Address City, State, Zip Make Check s Payable to “State of Oregon” Mail to: Circuit Court PO Box 100 Newport, OR 97365 Revised 05/04 American LegalNet, Inc. www.USCourtForms.com