Ex Parte Motion And Affidavit To Waive Transcript Fees {2F-P-360}

(Name) (Address) (Telephone No.) [ ]Plaintiff, Pro Se [ ]Defendant, Pro Se IN THE COURT OF THE SECOND CIRCUIT STATE OF HAWAI`I ) CASE NO. ))Plaintiff, ) ) vs. ) ) ) EX PARTE MOTION AND AFFIDAVIT TO WAIVE TRANSCRIPT FEES UNDER HAWAI`I REVISED STATUTES SECTION 607-(b); ORDER [ ] GRANTING [ ] DENYING EX PARTE MOTION )) Defendant. ) EX PARTE MOTION AND AFFIDAVIT TO WAIVE TRANSCRIPT FEES UNDER HAWAI`I REVISED STATUES SECTION 607-5(b) Plaintiff/Defendant in the above-entitled action submits his/her motion to waive the transcript fees, required by HRS Section 607-(b) and, being first duly sworn on oath, deposes and says that: 1.Because of my poverty, I am unable to pay the transcript fees and I believe I amentitled to relief. 2.My gross monthly income from all sources is $, I receivemoney from: (check all that apply)a.[ ] job $ b. [ ] welfare $ c.[ ] food stamps $ d. [ ] unemployment benefits $ e.[ ] social security $ f.[ ] child support $ g.[ ] part-time or side-jobs $ h.[ ] other: $ 3.I help to support(fill in #) dependents in my household, not including myself. American LegalNet, Inc. www.FormsWorkFlow.com 4.Within the past twelve months, I received money from the following sources:(check all that apply)a.[ ] business, profession or form of self-employment $ b.[ ] rent payments, interest or dividends $ c.[ ] pensions, investments, annuities, or life insurance payments $ d.[ ] gifts or inheritances $ e.[ ] disability payments, lawsuit damages, etc$ f.[ ] other: $ 5.My total assets (including but not limited to cash, bank accounts, real estate, stocks, bonds, cars, etc.) are $ . 6.I own the following: (check all that apply)a.[ ] house, townhouse, condo, other real property worth$ b.[ ] pager, cellular phone, computer worth$ c.[ ] jewelry worth$ d. [ ] car, van, truck, motorcycle, boat, etc. worth $ 7. I have a total amount of debts $ , owed on the following: a.[ ] mortgage$ b. [ ] credit cards $ c.[ ] loans$ d. [ ] other: $ I swear under penalty of perjury that the foregoing is true and correct. FURTHER AFFIANT SAYETH NAUGHT. [ ]Plaintiff [ ]Defendant Subscribed and sworn to before me on this day of , 2017 Notary Public, State of Hawai`i My commission expires: [ ] MOTION DENIED [ ] WAIVER OF TRANSCRIPT FEES APPROVED AND SO ORDERED SUBJECT TO REIMBURSEMENT UPON ORDER OF THE COURT DATED: WAILUKU, HAWAI`I Judge of the Above-Entitled Court American LegalNet, Inc. www.FormsWorkFlow.com