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Motion And Affidavit For Fee Waiver CAO 1-10A - Idaho
| Motion And Affidavit For Fee Waiver Form. This is a Idaho form and can be used in Family Law District Court Statewide . |
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__________________________________________ Full Name of Party Filing This Document __________________________________________ Mailing Address (Street or Post Office Box) __________________________________________ City, State and Zip Code __________________________________________ Telephone Number IN THE DISTRICT COURT OF THE ___________________ JUDICIAL DISTRICT OF THE STATE OF IDAHO, IN AND FOR THE COUNTY OF _____________________ _____________________________________, Plaintiff, vs. _____________________________________, Defendant STATE OF IDAHO County of _ ) ) ss. ) Case No.: ___________________ MOTION AND AFFIDAVIT FOR FEE WAIVER [ ] Plaintiff [ ] Defendant asks to start or defend this case without paying fees, Idaho Code Section 31-3220, and swears under oath: 1. This is an action for (type of case) . 2. I am unable to pay the court costs. I verify that the statements made in this Affidavit are true and correct. I understand that a false statement in this Affidavit is perjury and I could be sent to prison for one to 14 years. The waiver of payment does not prevent the court from later ordering me to pay costs and fees. MOTION AND AFFIDAVIT FOR FEE WAIVER CAO 1-10A 2/25/2005 American LegalNet, Inc. www.USCourtForms.com PAGE 1 Do not leave any items blank. If any item does not apply, write "N/A". Attach additional pages if more space is needed for any response. IDENTIFICATION AND RESIDENCE: Name: Other name(s) I have used: Address: How long at that address? Date and place of birth: Education completed (years): __________ FAMILY: Marital Status: [ ] Single [ ] Married [ ] Divorced [ ] Widowed [ ] Separated Phone: The following minor children live with me: Name Age Relationship Child Support Received ($/month) EMPLOYMENT: Occupation: ______________________ Employed by: _______________________________ Position: Salary: $ or $ per hour Monthly gross income $____________________. If your current position is temporary what are the start and end dates? _______________________________________________ Phone number to use to verify: one year, previous employer: Phone number to use to verify: . . If you have held this job less than . Spouse's Occupation: ______________________. Employed by: ________________________ MOTION AND AFFIDAVIT FOR FEE WAIVER CAO 1-10A 2/25/2005 American LegalNet, Inc. www.USCourtForms.com PAGE 2 Position: Salary: $ or $ per hour Monthly gross income $____________________. If your spouse's current position is temporary what are the start and end dates? ______________________________________ I receive assistance or support from the following sources and in the following monthly amounts: Spouse: $ Welfare: $ Food Stamps: $ Social Security: $ Relatives: $ Retirement: $ $ Unemployment Compensation: $ Former Spouse: $__________ Other (identify) If unemployed, how long since your last regular employment? List all places where you have applied for work in the last six months: Company Last Applied Reason for Rejection Are you willing to work now? What work can you do? What is the minimum wage for which you are willing to work? $_ List all employers you worked for during the last three years. Company Date Terminated Ending Salary _________ Reason for Termination Are you capable of working now? [ ] Yes [ ] No If no, why not? If a health problem keeps you from working, provide the name of your treating doctor: . Is your health problem permanent? [ ] Yes MOTION AND AFFIDAVIT FOR FEE WAIVER CAO 1-10A 2/25/2005 American LegalNet, Inc. www.USCourtForms.com [ ] No PAGE 3 When will you be released to work? ASSETS: List all real property (land and buildings) owned or being purchased by you. Legal Address City State Description Value Your Equity List all other property owned by you and state its value. Description (provide description for each item) Cash Notes and Receivables Vehicles: Bank/Credit Union/Savings/Checking Accounts Stocks/Bonds/Investments/Certificates of Deposit Trust Funds Retirement Accounts/IRAs/401(k)s Cash Value Insurance Motorcycles/Boats/RVs/Snowmobiles: Furniture/Appliances Jewelry/Antiques/Collectibles TVs/Stereos/Computers/Electronics Tools/Equipment Sporting Goods/Guns Horses/Livestock/Tack Other (describe) Value MOTION AND AFFIDAVIT FOR FEE WAIVER CAO 1-10A 2/25/2005 PAGE 4 American LegalNet, Inc. www.USCourtForms.com EXPENSES: List all of your monthly expenses. Expense Rent/House Payment Vehicle Payment(s) Credit Cards (list last 4 digits of each account number) ____________________________________________________________________________ Average Monthly Payment Loans: (name of lender and reason for loan) (Loans) Electricity/Natural Gas Water/Sewer/Trash Phone Cellular Phone Cable/Satellite TV/Internet Groceries Dining Out Clothing Auto Fuel/Transportation Auto Maintenance Cosmetics/Haircuts/Salons Entertainment/Books/Magazines Home Insurance Auto Insurance Life Insurance MOTION AND AFFIDAVIT FOR FEE WAIVER CAO 1-10A 2/25/2005 PAGE 5 American LegalNet, Inc. www.USCourtForms.com Expense (continued) Medical Insurance Medical Expense Child Care Other Average Monthly Payment MISCELLANEOUS: How much can you borrow? $ When did you file your last income tax return? From whom? Amount of refund: $ _____ PERSONAL REFERENCES: (These persons must be able to verify information provided.) Name Address Phone Years Known ___________________________________ Signature ___________________________________ Typed/Printed Name SUBSCRIBED AND SWORN TO before me this ______ day of __________________, 20____. ___________________________________ Notary Public for Idaho Residing at My Commission expires MOTION AND AFFIDAVIT FOR FEE WAIVER CAO 1-10A 2/25/2005 PAGE 6 American LegalNet, Inc. www.USCourtForms.com
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