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Request To Postpone Filing Fees And Order Form 3 - Tennessee

Request To Postpone Filing Fees And Order Form. This is a Tennessee form and can be used in Circuit Court Davidson Local County .
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IN THE ____________ CIRCUIT COURT FOR DAVIDSON COUNTY, TENNESSEE Plaintiff vs. [NAME (First, Middle, Last) OF SPOUSE FILING THE DIVORCE] Docket No: [NAME (First, Middle, Last) OF THE OTHER SPOUSE] Defendant Request to Postpone Filing Fees and Order If you think you cannot afford to pay the filing fees at this time: · Fill out this form; and · File it with your Complaint for Divorce (FORM 1) Your Information: Address: Street Address Telephone: (H): Birth Date (mm/dd/yy): (W): City (C): State Zip Dependents: List your children below. Include your biological, adopted, step, and foster children. Also list other dependent relatives if they live with you for at least 6 months of the year and are: · Under 19; · Under 24 if full-time student (must live with you at least 5 months of the year); or · Any age with a permanent disability. Name 1. 2. 3. 4. 5. 6. 7. Age Relationship March 2012 (FORM 3) Request to Postpone Filing Fees and Order Approved by the Tennessee Supreme Court To request an ADA accommodation, please contact Dart Gore at 880-3309. Page 1 American LegalNet, Inc. www.FormsWorkFlow.com Employment: If you are working now, fill out information below. If not working now, check here: Employer's Name: Employer's Address and Telephone Number: Street Address How much do you earn after taxes are deducted? $ each (check one) City State Zip Phone # week month other: Other Income: List any other income that you receive now or expect to receive. Source of Income How much do you receive? $ $ $ $ / month / month / month / month Source of Income How much do you receive? $ $ $ $ / month / month / month / month AFDC Social Security Retirement Disability Unemployment Worker's Comp. Other* SSI * Explain source of "Other" income here: Assets: List all assets that you own separately, with your spouse, or with someone else. Fair Market Value 1. Car, truck, or other vehicle 2. Other car, truck, or other vehicle 3. House, condominium or land 4. Other house, condominium or land List All Bank/Financial Accounts Below: Bank Name 5. 6. 7. Cash Total: Other: Account Number $ $ $ $ Balance $ $ $ $ [­] Money Still Owed $ $ $ $ [=] $ $ $ $ March 2012 (FORM 3) Request to Postpone Filing Fees and Order Approved by the Tennessee Supreme Court To request an ADA accommodation, please contact Dart Gore at 880-3309. Page 2 American LegalNet, Inc. www.FormsWorkFlow.com Expenses: How much each month? How much each month? Rent/House Payment Phone Groceries School Supplies Electricity Clothing Water $ $ $ $ $ $ $ Gas Child Care Court-ordered Child Support Transportation $ $ $ $ $ $ $ Medical/Dental Other Other Debts: Who do you owe? 1. 2. 3. 4. 5. 6. $ $ $ $ $ $ How much do you owe? I declare under penalty of perjury under the laws of the State of Tennessee that: · · The information I have provided is true, correct, and complete. I cannot afford to pay the filing fees at this time. Sign here: Date: Judge's Order: Based on the information above and the Plaintiff's answers (check one): This Request is approved, and the Plaintiff may file without paying the filing fees at this time. This Request is denied because (explain): This Order is made on (date): By: Judge's Signature March 2012 (FORM 3) Request to Postpone Filing Fees and Order Approved by the Tennessee Supreme Court To request an ADA accommodation, please contact Dart Gore at 880-3309. Page 3 American LegalNet, Inc. www.FormsWorkFlow.com
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