Supplemental Application For Waiver Or Further Deferral Of Court Fees And Costs {AOC DFGF9F} | Pdf Fpdf Docx | Arizona

 Arizona /  Statewide /  Fee Waiver And Deferral /
Supplemental Application For Waiver Or Further Deferral Of Court Fees And Costs {AOC DFGF9F} | Pdf Fpdf Docx | Arizona

Supplemental Application For Waiver Or Further Deferral Of Court Fees And Costs {AOC DFGF9F}

This is a Arizona form that can be used for Fee Waiver And Deferral within Statewide.

Alternate TextLast updated: 7/29/2019

Included Formats to Download
$ 15.99

Description

Arizona Supreme Court Page 1 of 3 AOC DFGF9F-071017 Revised July 10, 2017 (COURT222S JURISDICTIONAL NAME AND ADDRESS HERE) Name of Person Filing Document: Your Address: Your City, State, and Zip Code: Your Telephone Number: Attorney Bar Number (if applicable): Attorney E-mail Address : Representing Self (Without an Attorney) OR Attorney for Petitioner Respondent STATE OF ARIZONA ) COUNTY OF ) ss Case Number: Name of Petitioner/Plaintiff SUPPLEMENTAL APPLICATION FOR DEFERRAL OR WAIVER OF COURT FEES AND/OR COSTS Name of Respondent/Defendant Notice. A Fee Deferral is only a temporary postponement of the payment of the fees due. You may be required to make payments depending on your income. A Fee Waiver is usually permanent unless your financial circumstances change during the pendency of this court action. I am requesting a deferral/waiver of any unpaid fees and/or costs in my case. I understand that if I request deferral or waiver because I am a participant in a government assistance program, I am required to provide proof at the time of filing. The document(s) submitted must show my name as the recipient of the benefit and the name of the agency awarding the benefit. Note. All other applicants must complete the financial questionnaire beginning at section 3. 1. [ ] WAIVER: [ ] I currently receive government assistance from the federal Supplemental Security Income (SSI) program. (Please attach proof.) [ ] I was formerly granted a deferral by the court until the end of my case. My income and liquid assets have not changed and are unlikely to change in the foreseeable future. (If you are receiving food stamps or government cash assistance from Temporary Assistance to Needy Families (TANF), please attach proof. In all other cases, complete the financial questionnaire in section 3.) [ ] My income is insufficient or is barely sufficient to meet the daily essentials of life, and includes no allotment that could be budgeted for the fees and costs that have accrued. My gross income as computed on a monthly basis is 150% or less of the current federal poverty level. (Complete the financial questionnaire in section 3. Note: Gross monthly income includes your share of community property income if available to you.) [ ] My income is greater than 150% of the poverty level, but I have proof of extraordinary expenses (including medical expenses and costs of care for elderly or disabled family members) or other expenses that reduce my gross monthly income to 150% or below the poverty level. (Complete the financial questionnaire in section 3.) American LegalNet, Inc. www.FormsWorkFlow.com Arizona Supreme Court Page 2 of 3 AOC DFGF9F-071017 Revised July 10, 2017 2. [ ] DEFERRAL: I do not have the money to pay court filing fees and/or costs now. I can pay the filing fees and/or costs at a later date. Explain. (Complete the financial questionnaire in section 3.) 3. FINANCIAL QUESTIONNAIRE SUPPORT RESPONSIBILITIES. List all persons you support (including those you pay child support and/or spousal maintenance/support for): NAME RELATIONSHIP STATEMENT OF INCOME AND EXPENSES Employer name: Employer phone number: [ ] I am unemployed (explain): My prior year222s gross income: $ MONTHLY INCOME My total monthly gross income: $ My spouse222s monthly gross income (if available to me): $ Other current monthly income, including spousal maintenance/support, retirement, rental, interest, pensions, and lottery winnings: $ TOTAL MONTHLY INCOME $ MONTHLY EXPENSES AND DEBTS: My monthly expenses and debts are: PAYMENT AMOUNT LOAN BALANCE Rent/Mortgage payment $ $ Car payment $ $ Credit card payments $ $ Explain: Other payments & debts $ $ Household $ Utilities/Telephone/Cable $ Medical/Dental/Drugs $ Health insurance $ Nursing care $ Tuition $ Child support $ Child care $ Spousal maintenance $ Car insurance $ Transportation $ Other expenses (explain) $ TOTAL MONTHLY EXPENSES $ American LegalNet, Inc. www.FormsWorkFlow.com Arizona Supreme Court Page 3 of 3 AOC DFGF9F-071017 Revised July 10, 2017 STATEMENT OF ASSETS: List only those assets available to you and accessible without financial penalty. ESTIMATED VALUE Cash and bank accounts $ Credit union accounts $ Other liquid assets $ TOTAL ASSETS $ OATH OR AFFIRMATION I declare under penalty of perjury that the foregoing is true and correct. Date Signature Applicant 222 s Printed Name Date Judici al Officer, Deputy Clerk or Notary Public My Commis s ion Expires/Seal: American LegalNet, Inc. www.FormsWorkFlow.com

Our Products