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Motion And Affidavit For Waiver Of Mediation Fees - Florida

Motion And Affidavit For Waiver Of Mediation Fees Form. This is a Florida form and can be used in Mediation 5th District District Courts Of Appeal Appellate Courts .
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IN THE DISTRICT COURT OF APPEAL FOR THE STATE OF FLORIDA FIFTH DISTRICT Appellant(s), v. Appellate Case No. 5D County Case No. Appellee(s) _________________________________/ DATE: MOTION FOR WAIVER OF MEDIATION FEES Appellant(s), , through undersigned counsel, hereby move(s) for waiver of mediator's fees and, in support thereof, submits the attached affidavit, and would state that payment of such fees would create an undue financial burden for the following reasons: I hereby certify that the above information is true and correct. ________________________________ Appellant(s), (Name) (Address) (City/State/Zip) ________________________________ Attorney for Appellant(s) (Name) (Address) (City/State/Zip) NOTE: Signatures by both party and counsel are required. CERTIFICATE OF SERVICE (Counsel's Certificate of Service that complies with Florida Rule of Appellate Procedure 9.420(d)(1) must be attached to this motion) This motion and attached affidavit should be e-filed with the Fifth District Court of Appeal via this Court's eDCA portal, located at www.5dca.org. American LegalNet, Inc. www.FormsWorkFlow.com IN THE DISTRICT COURT OF APPEAL FOR THE STATE OF FLORIDA FIFTH DISTRICT Appellant(s), v. Appellate Case No. 5D County Case No. Appellee(s) _________________________________/ AFFIDAVIT IN SUPPORT OF MOTION FOR WAIVER OF MEDIATION FEES I, , being first duly sworn, depose and make under oath the following statement regarding my age, marital status, dependents, and financial condition. AGE: MARITAL STATUS: FINANCIAL CONDITION: Affiant's Gross Income: Weekly $ Bi-Weekly $ Bi-Weekly $ No No Monthly Payments $ Monthly $ Monthly $ DATE OF BIRTH: Married Separated DEPENDENTS: Divorced Single Spouse's Gross Income: Weekly $ Own Home Rent Home Yes Yes Monthly Rent Payment $ Value of Real Estate Owned [home, lot(s), etc.]: $ Own Automobile Value of Automobile $ Yes No Monthly Payment $ Year/Make $ Value of Personal Property Owned (boats, stocks, jewelry, etc.) Value of Personal Debt $ By: Signature of Affiant STATE OF FLORIDA COUNTY OF Address: SWORN TO AND SUBSCRIBED TO BEFORE ME THIS Personally known to me Produced identification: DAY OF 20 My Commission Expires: Notary Public, State of Florida Rev. 02-2007 American LegalNet, Inc. www.FormsWorkFlow.com
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