Request to Waive Court Fees

Cal. Form FW-001

California Superior Local Rules

Judicial Council of California, courts.ca.gov Rev. March 1, 2026, Mandatory Form Gov. Code, § 68633; Cal. Rules of Court, rules 3.51, 8.26, and 8.818 Request to Waive Court Fees FW-001 Request to Waive Court Fees CONFIDENTIAL Clerk stamps date here when form is filed. Fill in court name and street address: Superior Court of California, County of Fill in case number and name: Case Number: Case Name: If you are getting public benefits, are a low-income person, or do not have enough income to pay for your household’s basic needs and your court fees, you may use this form to ask the court to waive your court fees.

The court may order you to answer questions about your finances. If the court waives the fees, you may still have to pay later if: • You cannot give the court proof of your eligibility, • Your financial situation improves during this case, or • You settle your civil case for $10,000 or more. The trial court that waives your fees will have a lien on any such settlement in the amount of the waived fees and costs.

The court may also charge you any collection costs. 1 Your Information (person asking the court to waive the fees): Name: Street or mailing address: City: State: Zip: Phone: 2 Your Job, if you have one (job title): Name of employer: Employer’s address: 3 Your Lawyer, if you have one (name, firm or affiliation, address, phone number, and State Bar number): a. The lawyer has agreed to advance all or a portion of your fees or costs (check one): Yes No (If yes, your lawyer must sign here) Lawyer’s signature:b.

If your lawyer is not providing legal-aid type services based on your low income, you may have to go to a hearing to explain why you are asking the court to waive the fees. 4 What court’s fees or costs are you asking to be waived? Superior Court (See Information Sheet on Waiver of Superior Court Fees and Costs (form FW-001-INFO).) Supreme Court, Court of Appeal, or Appellate Division of Superior Court (See Information Sheet on Waiver of Appellate Court Fees (form APP-015/FW-015-INFO).) 5 Why are you asking the court to waive your court fees? a. I receive (check all that apply; see form FW-001-INFO for

definitions): Food Stamps Supp. Sec. Inc. SSP Medi-Cal County Relief/Gen. Assist. IHSS CalWORKS or Tribal TANF CAPI WIC Unemployment b. My gross monthly household income (before deductions for taxes) is less than the amount listed below. (If you check 5b, you must fill out 7, 8, and on page of this form.) Family Size Family Income Family Size Family Income Family Size Family Income 1 $2,660.00 3 $4,553.33 5 $6,446.67 2 $3,606.67 4 $5,500.00 6 $7,393.33 If more than people at home, add $946.67 for each extra person. c. I do not have enough income to pay for my household’s basic needs and the court fees.

I ask the court to: (check one and you must fill out page 2): waive all court fees and costs waive some of the court fees let me make payments over time Check here if you asked the court to waive your court fees for this case in the last six months. (If your previous request is reasonably available, please attach it to this form and check here): I declare under penalty of perjury under the laws of the State of California that the information I have provided on this form and all attachments is true and correct.

Date: Print your name here Sign here FW-001, For your protection and privacy, please press the Clear button after you have printed the form. Rev. March 1, 2026 Request to Waive Court Fees Your name: Case Number: If you checked 5a on page 1, do not fill out below. If you checked 5b, fill out questions 7, 8, and only. If you checked 5c, you must fill out this entire page. If you need more space, attach form MC-025 or attach a sheet of paper and write Financial Information and your name and case number at the top. 7 Check here if your income changes a lot from month to month.

If it does, complete the form based on your average income for the past 12 months. 8 Your Gross Monthly Income a. List the source and amount of any income you get each month, including: wages or other income from work before deductions, spousal/child support, retirement, social security, disability, unemployment, military basic allowance for quarters (BAQ), veterans payments, dividends, interest, trust income, annuities, net business or rental income, reimbursement for job-related expenses, gambling or lottery winnings, etc. (1) $ (2) $ (3) $ (4) $ b. Your total monthly income: $ 9 Household Income a.

List the income of all other persons living in your home who depend in whole or in part on you for support, or on whom you depend in whole or in part for support. Name Age Relationship Gross Monthly Income (1) $ (2) $ (3) $ (4) $ b. Total monthly income of persons above: $ Total monthly income and household income (8b plus 9b): $ 10 Your Money and Property a. Cash $ b. All financial accounts (List bank name and amount): (1) $ (2) $ (3) $ c. Cars, boats, and other vehicles Make / Year Fair Market Value How Much You Still Owe (1) $ $ (2) $ $ (3) $ $ d.

Real estate Address Fair Market Value How Much You Still Owe (1) $ $ (2) $ $ e. Other personal property (jewelry, furniture, furs, stocks, bonds, etc.): Describe Fair Market Value How Much You Still Owe (1) $ $ (2) $ $ 11 Your Monthly Deductions and Expenses a. List any payroll deductions and the monthly amount below: (1) $ (2) $ (3) $ (4) $ b. Rent or house payment & maintenance $ c. Food and household supplies $ d. Utilities and telephone $ e. Clothing $ f. Laundry and cleaning $ g. Medical and dental expenses $ h. Insurance (life, health, accident, etc.) $ i.

School, child care $ Child, spousal support (another marriage)j. $ Transportation, gas, auto repair and insurance k. $ l. Installment payments (list each below): Paid to: (1) $ (2) $ (3) $ m. Wages/earnings withheld by court order $ n. Any other monthly expenses (list each below). Paid to: How Much? (1) $ (2) $ (3) $ Total monthly expenses (add 11a –11n above): $ To list any other facts you want the court to know, such as unusual medical expenses, etc., attach form MC-025 or attach a sheet of paper and write Financial Information and your name and case number at the top. Check here if you attach another page.

Important! If your financial situation or ability to pay court fees improves, you must notify the court within five days on form FW-010. FW-001,

Document details

Collection	California Superior Local Rules
Citation	Cal. Form FW-001
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	1598610f7d2ed5665c29adef535b6c607c2276ad

Source file is stored in the law ingest library (pdf).