Application For Waiver Of Filing Fee

Fill-In Form Instructions: Tax Court forms can be filled in and printed directly from Actobat Reader 3.0 (or later). However, the information entered on a form cannot be saved to a disk unless you are using the full Adobe Acrobat software suite. Clicking on a form link will launch the Acrobat Reader plug-in and display the form within your browser window (please note the Acrobat toolbar that appears across the top of the form within the browser). You may also wish to download the form directly to your hard drive to fill in later. To do so, right-click on the form link and select "Save Target As..." (Internet Explorer) or "Save Link As..." (Netscape Navigator) to save the form file to a disk. Filling In the Form: · Move the mouse pointer over a blank field (e.g. Petitioner(s) name(s)) on the form. The mouse pointer will turn into a vertical I-beam, indicating that the field is editable. Click the left mouse button once within the field and begin typing. Press the tab key to move forward through the form. Press shift+tab to move backwards. When you have completed the form, click once on a blank area of the form to deselect the last active field. If a field is left active, the information it contains will not print. Click the print icon on the Acrobat Reader toolbar to print the form. · · · · American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES TAX COURT WASHINGTON, DC 20217 , Petitioner (your name) v. COMMISSIONER OF INTERNAL REVENUE, Respondent Docket No. APPLICATION FOR WAIVER OF FILING FEE 1. Do you receive any money from any of the following sources? If "Yes", amount received per month: a. Salary or wages b. Business, profession, or other self-employment c. Rent payments, interest, or dividends d. Pensions, annuities, or life insurance payments e. Disability or workers compensation payments f. Any other sources 2. Do you have any cash or checking or savings accounts? If "Yes", state the total amount. ____________________ 3. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles, or any other thing of value? G YES G NO If "Yes", describe the property and state its value. G YES G YES G YES G YES G YES G YES G YES G NO G NO G NO G NO G NO G NO G NO 1 of 2 (08/13) American LegalNet, Inc. www.FormsWorkFlow.com 4. List the persons who depend on you for support (if under 18, list initials only), state your relationship to each person, and indicate how much you contribute to their support per month. 5. Do you have any debts, financial obligations or other additional circumstances you want the Court to consider (such as incarceration) in deciding whether to waive the filing fee? If yes, describe the amounts owed and to whom they are payable and the other circumstances you want considered. I declare under penalty of perjury that the above information is true and correct. _____________________________ ____________________________________________________ Date Signature of Applicant Return the completed application to: Office of Clerk of the Court United States Tax Court 400 Second Street, NW Washington, DC 20217 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com