IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR LINCOLN COUNTY In the Ma tter of the M arriage o f ___________________________________ Petitioner and ___________________________________ Respondent ) ) ) ) ) ) ) ) Case No._______________________ PETITIONER’S MOTION FOR ORDER WAIVING FEES AND COSTS; and ORDER MOTION Based on the attached Affidavit, Petitioner requests that this court grant an order waiving or deferring payment of filing fees, service fees, and other court costs. ____________________________________________ Signature of Petitioner Date ____________________________________________ Print or Type Name of Petitioner ____________________________________________ Address or Contact Address ____________________________________________ City State Zip ____________________________________________ Telephone or Contact Telephone Number STATEMENT OF POINTS AND AUTHOR ITIES OR S 21 .605 auth orize s the Cou rt to w aive or de fer filing fees , serv ice fe es, a nd co urt co sts in whole or in part if the Court finds that the party is unable to pay such fees and costs. PETITIONER’S MOTION FOR ORDER WAIVING FEES AND COSTS; AND ORDER - Page 1 of 2 2001 © American LegalNet, Inc. ORDER IT IS ORDERED that Petitioner’s fees and costs be waived or deferred in whole or in part as follows: (specify amount waived or deferred for each - if waived or deferred in whole, list amount as “all”) Type Amount Waived Amount Deferred Amount Remaining Filing Fee _____________ ______________ ________________ Law Library Fee _____________ ______________ ________________ Legal Aid Fee _____________ ______________ ________________ Conciliation/Mediation Fee _____________ ______________ ________________ Children’s Ombudsm an Fee _____________ ______________ ________________ Dispute Resolution Surcharge _____________ ______________ ________________ Service Fees* _____________ ______________ ________________ *[____] T he Co urt finds tha t the mov ing party h as ma de an ins ufficient sho wing of h is/her inab ility to arra nge for a th ird pe rson to se rve th e plea dings /pap ers in this c ase , and there fore it is the o rder of this Court that service fees NOT be waived. Other C osts (sp ecify type /amou nt) _____________________ ______________ ______________ ________________ _____________________ ______________ ______________ ________________ Dated this ______ day of ____________________, 20____ ______________________________________ Circuit Judge ______________________________________ Print, Type or Stamp Judge’s Name Submitted by: ______________________________________ Print Name _____ Petitioner _____ Attorney for Petitioner, OSB No._______ ______________________________________ Address or Contact Address ______________________________________ City State Zip ______________________________________ Telephone or Contact Telephone Numbers PETITIONERS MOTION FOR ORDER WAIVING FEES AND COSTS; AND ORDER - Page 2 of 2 2001 © American LegalNet, Inc.