STATE OF WASHINGTON KING COUNTY DISTRICT COURT East Division, Bellevue Courthouse NO. Petitioner MOTION FOR WAIVER OF FEES (HARASSMENT)(MT) vs Respondent I. MOTION Based on the declaration below, I move the court for an order: 1.1 1.2 1.3 Permitting me to proceed without payment of filing or any other court related fees, or service fees; Directing the clerk of the court to file the pleadings without payment of filing or any other court related fees; and Directing the (Law Enforcement agency where respondent lives) to serve the papers in this action upon respondent without charging fees for the service. Dated: __________________________________ Petitioner II. DECLARATION 2.1 I lack the funds to pay the $ __________________ cost of filing or the other fees in this proceeding. I have the following assets available: $_________ Cash 2.2 $_________________ $_________________ Checking Account Savings Account $_________ Other My total monthly income is $_____________________. Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com 2.4 The source of this income is (describe employment, other sources): 2.5 My total monthly expenses are $ _______________. 2.6 I have people living in my household, including minor child(ren). I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Dated __________________________ at ________________________________ , Washington. Petitioner Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com