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					FW-004
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY

COURT COUNTY .OF. . . . . . . . . . . . . . . . .FAX .NO.: . . . . . . . . . . . . . . . . . . . . TELEPHONE NO.: . . . . . . . . . . . .. .. E-MAIL ADDRESS (Optional): :
ATTORNEY FOR (Name):

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SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

: Plaintiff(s) : : :

JUDICIAL SUBPOENA

-against-

PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT:

: ORDER ON APPLICATION FOR WAIVER OF ADDITIONAL Defendant(s) COURT FEES AND COSTS (Cal. Rules of Court, rule 3.62) : ......................................................

CASE NUMBER:

1. The application was filed on (date): A previous order was issued on (date): 2. The application was filed by (name): in part (complete item 4 below). 3. in whole IT IS ORDERED PEOPLE OF THE STATE OF NEW YORK THE that the application is granted a. No payments. Payment of all the fees and costs listed in California Rules of Court, rule 3.62, is waived. b. Applicant shall pay all the fees and costs listed in California Rules of Court, rule 3.62, EXCEPT the following: TO (1) (5) Court-appointed experts. Jury fees and expenses. (2) Court-appointed interpreter for witnesses. (6) Other fees and costs (specify): Witness fees of peace officers. (3) (4) Reporter’s GREETINGS: fees (beyond 60 days). c. Method of payment. Applicant shall pay all the fees and costs when charged, EXCEPT as follows: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before (1) Pay (specify): percent. , the Honorable at the Court Pay: $ (2) per month or more until the balance is paid. locatedappropriate county officer is authorized to require the applicant to appear at County of d. The clerk of the court, county financial officer, or in be examined by on the no day of than four months from the date of thisin the andnoon, and than once in , the court , 20 , at o'clock order, before androom sooner not more at any recessed any four-month period. or adjourned date, to testify and give evidence as a witness in this action on the part of the The applicant is ordered to appear for the court’s review of the applicant’s financial status as follows: Date: Time: Dept.: Room: The clerk is Your failure to comply with this subpoena is punishable as attorney or to the applicant if make you liable to directed to mail a copy of this order only to the applicant’s a contempt of court and will not represented. e. the fees andwhose behalfbe deemed to be taxable costsmaximum penalty of $50 and all damages sustained as a party on costs shall this subpoena was issued for a if applicant is entitled to costs and shall be a lien f. All unpaid on any result of your failure to comply. judgment recovered by the applicant and shall be paid directly to the clerk by the judgment debtor upon such recovery. in whole in part IT IS ORDERED that the application is denied Witness, Honorable , one of the Justices of the for the following reasons (see Cal. Rules of Court, rules 3.50–3.63): Court in County, day of (Gov. Code, § 68511.3(a)(6)(B); form FW-001-INFO). , 20 a. Monthly household income exceeds guidelines Other (Complete line 4b on page 2). b. c. The applicant shall pay any fees and costs due in this action within 10 days from the date of service of this order or any (Attorney must sign above and type name below) paper filed by the applicant with the clerk will be of no effect. d. The clerk is directed to mail a copy of this order to all parties who have appeared in this action. IT IS ORDERED that a hearing be held. Attorney(s) for a. The substantial evidentiary conflict to be resolved by the hearing is (specify): b. Applicant should be present at the hearing to be held as follows: Date: c. The address of the court is (specify): Time: Dept.: Room:

4.

5.

Office and P.O. Address

Same as above d. The clerk is directed to mail a copy of this order only to the applicant’s attorney or to the applicant if not represented. Date:
Form Adopted for Mandatory Use Judicial Council of California FW-004 [Rev. January 1, 2007] JUDICIAL OFFICER (Clerk may GRANT in full a nondiscretionary fee waiver; see Cal. Rules of Court, rule 3.56.)

Telephone No.: Clerk, by

, Deputy
Page 1 of 2 Government Code, § 68511.3; Cal. Rules of Court, rules 3.50–3.63 www.courtinfo.ca.gov
American LegalNet, Inc. www.FormsWorkflow.com

Facsimile No.: E-Mail Address: ORDER ON APPLICATION FOR WAIVER OF Mobile ADDITIONAL COURT FEES AND COSTSTel. No.:
(Fee Waiver)

FW-004
PLAINTIFF/PETITIONER (Name): DEFENDANT/RESPONDENT (Name):
CASE NUMBER:

4b

Application is denied in whole or in part (specify reasons):

CLERK'S CERTIFICATE OF MAILING
I certify that I am not a party to this cause and that a true copy of the foregoing was mailed first class, postage prepaid, in a sealed envelope addressed as shown below, and that the mailing of the foregoing and execution of this certificate occurred at , California, (place): on (date): Clerk, by , Deputy

(SEAL)

CLERK'S CERTIFICATE
I certify that the foregoing is a true and correct copy of the original on file in my office.

Date:

Clerk, by

, Deputy

FW-004 [Rev. January 1, 2007]

ORDER ON APPLICATION FOR WAIVER OF ADDITIONAL COURT FEES AND COSTS
(Fee Waiver)
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posted:11/17/2007
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