DISTRICT COURT OF WASHINGTON FOR KITSAP COUNTY 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 $_______________ __ $_______________ __ $________ _ Checking Account $_________ Savings Account Other 2.2 My total monthly income is $_____________________. 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 MT FOR WAIVER OF FEES (HARASSMENT) (MT) - Page 1 of 2 UH-02.0100 (9/2000) - RCW 10.14.060 American LegalNet, Inc. www.FormsWorkflow.com