Indigent Fee Waiver Form

INDIGENT FEE WAIVER FORM. This is a Georgia Office of Dispute Resolution form used by a party who is unable to afford the cost of court-ordered mediation and seeks a full waiver or reduction of mediation fees. This form applies to cases referred to mediation by a judge within the Seventh Judicial Administrative District. The requesting party must submit the completed affidavit, along with a copy of their most recent federal tax return, to the ADR Office at least ten (10) days before the scheduled mediation. The form requires sworn financial disclosures, including employment status, monthly income, household members, assets, debts, housing costs, and extraordinary expenses. The affiant must also indicate whether they are self-represented or represented by counsel. The affidavit is signed under oath before a notary public, and false statements may result in penalties. www.FormsWorkflow.com