Connecticut > Statewide > Probate
Application Or Temporary Administrator For Limited Pusposes PC-207 - Connecticut
| Application Or Temporary Administrator For Limited Pusposes Form. This is a Connecticut form and can be used in Probate Statewide . |
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REQUEST/ORDER WAIVER OF FEES - PETITIONER PC-184 REV. 1/13 67$7( 2) &211(&7,&87 &2857 2) 352%$7( [Type or print in black ink.] ',675,&7 12 RESPONDENT DO NOT RECORD 72 &2857 2) 352%$7( PETITIONER APPLICANT IN PROCEEDINGS FOR: The petitioner represents that the GROSS MONTHLY household income from employment is: $ NET MONTHLY INCOME shown below after deductions for: State withholding FICA and Medicare $ Federal withholding $ Union dues $ Wage executions $ Other ,leaving the $ $ (Please attach a copy of paycheck stub(s) for each employed household member, and explain "Other" deductions on reverse side.) 1(7 0217+/< ,1&20( )520 (03/2<0(17 $ The petitioner further represents that other household income (broken down monthly) is as follows: Welfare Social Security Unemployment Compensation $ $ $ Pension Alimony Other income (Please explain on reverse side.) $ $ $ 727$/ 0217+/< ,1&20( )520 $// 6285&(6 The petitioner further represents that the total value of the petitioner's household assets (bank accounts, etc.) is: The petitioner further represents that the basic expenses of the petitioner's household (broken down monthly) are: Rent RU mortgage Utilities Food $ $ $ Medical and Dental Clothing Other (Please explain on reverse side.) $ $ $ $ $ Total Monthly Expenses $ The petitioner further represents that the number of household members (including the petitioner) supported by the petitioner is WHEREFORE THE PETITIONER REQUESTS that WKH Court grant a waiver RI payment of: Application Fee State Marshal's Fees Other fees/expenses (Explain below.) related WR WKH aforementioned proceeding EHIRUH WKLV Court due WR KLV RU KHU inability WR pay IRU such IHHV and expenses. 7KH UHSUHVHQWDWLRQV FRQWDLQHG KHUHLQ DUH PDGH XQGHU WKH SHQDOWLHV RI IDOVH VWDWHPHQW Date: ......................................................................... Petitioner: COURT OF PROBATE, PRESIDING JUDGE: Hon. The foregoing request having been presented WR WKLV Court, WKH COURT FINDS that WKH above-named petitioner WR a waiver RI IHHV and expenses as indicated above. DISTRICT NO. LV LV not entitled LV granted WHEREFORE LW LV ORDERED and DECREED that a waiver RI payment RI all court fees and expenseV as indicated above LV denied. Dated at: ,Connecticut, on [Month, Day, Year] ................................................................. Judge REQUEST/ORDER WAIVER OF FEES - PETITIONER PC-184 American LegalNet, Inc. www.FormsWorkFlow.com
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