Do Not File Or Copy This Page JOINT APPLICATION TO WAIVE FEES AND COSTS F-6JP Self Help Center South Sierra St., First Floor Reno, NV 8950 775-325-673 www.washoecourts.com
Do Not File Or Copy This Page JOINT APPLICATION TO WAIVE FEES AND COSTS PACKET F-6JP Use this application only if all of the following statements are true: Both parties cannot afford filing fees and costs. INSTRUCTIONS FOR COMPLETING FORMS Carefully read all instructions before starting to fill out any of the forms. Use black or blue ink only. Neatly print the information requested. Do not use correction fluid/tape on the forms. This packet contains the following forms:. Joint Application for Waiver of Fees and Costs 2. Order Regarding Waiver of Fees and Costs 3. Request for Submission The penalty for willfully making a false statement under penalty of perjury is a minimum of year, and a maximum of 4 years in prison, in addition to a fine of not more than $5,000.00. N.R.S. 99.45. REV 2/209 JCB Self Help Center 775-325-673 F-6JP VISUAL INSTRUCTIONS Law Library 775-328-3250 Filing Office 775-328-30 x 7
INSTRUCTIONS: STEP Do Not File Or Copy This Page Complete the Joint Application to Waive Fees and Costs as Shown: ) Print your names, addresses, telephone numbers, and emails. 2) Print your names in the same order as you have put them on all other documents. The Filing Office will assign you a case number and department number when you file the documents. 3) Complete the application following the instructions on each page. REV 2/209 JCB Self Help Center 775-325-673 F-6JP VISUAL INSTRUCTIONS Law Library 775-328-3250 Filing Office 775-328-30 x 7
2 3 4 5 6 7 8 Code: 524 Name: Address: Telephone: Email: Self-Represented Litigant Name: Address: Telephone: Email: Self-Represented Litigant 9 0 2 IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE 3 4 5 6 7 8 9 20, Petitioner, and, Petitioner 2. / Case No. Dept. No. 2 JOINT APPLICATION TO WAIVE FEES AND COSTS 22 23 24 25 26 27 28 We declare that, pursuant to NRS 2.05, we are requesting permission from this Court to proceed without paying court costs or other costs and fees because we cannot afford to pay such expenses. // // REV 2/209 JCB F6JP APPLICATION
2 3 4. Petitioner s Information: Check each box that applies, you may need to check more than one box. Fill in requested information. If a person helps support you, list the amount of money they contribute each month. 5 6 Petitioner s Monthly Benefits Received: I receive benefits from one of more of the following programs (please check all that apply): 7 8 Supplemental Security Income (SSI); Temporary Assistance for Needy Families (TANF); Food Stamps; Client of Legal Services; 9 0 2 3 Medicaid Subsidized Housing through Reno Housing Authority. Petitioner s Monthly Money Earned and Received: I am working and my hourly wage is $. I work hours a week. I am not paid by the hour. I receive a salary in the following amount: per day, per week, per month, OR per year. 4 5 6 7 8 9 I receive commissions or tips each month in the following amount: I receive unemployment benefits each month in the following amount: I receive veterans or social security benefits (retirement, disability, widows, dependents, or survivor) each month in the following amount: I receive child support, spousal support, or alimony each month in the following amount: 20 I receive other sources of income (rent, military basic allowance for quarters (BAH), 2 22 trust payments, etc.) each month in the following amount: I receive pension or annuity payments each month in the following amount: 23 24 25 26 27 28 I am not employed at the present time and am not receiving any kind of income or benefits. (If you have check this box, please explain how you are meeting your basic living needs. For example, are you are living with others who are helping to support you, are you are in a homeless shelter, or are you meeting your needs in other ways? Please explain here) If more room is needed, attach additional sheets. REV 2/209 JCB 2 F6JP APPLICATION
2 3 4 5 6 7 8 9 0 2 3 4 5 6 7 Petitioner s List of Assets and Their Value: Motor Vehicle(s): What is it worth? Amount owed. (Print the Year, Make, and Model) Home or Real Estate other than where you live: What is it worth? Amount owed. (Print the Type of Property) Accounts or Other Personal Property (saving, checking, stocks, bonds, investments, retirement, jewelry, furs, furniture, etc.): (Print the Type of Account) What is it worth? Amount owed. 8 9 Cash in the amount of: 20 2 22 23 24 25 26 27 28 Who lives with you?: Name Age Relationship Monthly contribution to household. If more room is needed, attach additional sheets. REV 2/209 JCB 3 F6JP APPLICATION
2 3 4 2. Petitioner 2 s Information: Check each box that applies, you may need to check more than one box. Fill in requested information. If a person helps support you, list the amount of money they contribute each month. 5 6 Petitioner 2 s Monthly Benefits Received: I receive benefits from one of more of the following programs (please check all that apply): 7 8 Supplemental Security Income (SSI); Temporary Assistance for Needy Families (TANF); Food Stamps; Client of Legal Services; 9 0 2 3 Medicaid Subsidized Housing through Reno Housing Authority. Petitioner 2 s Monthly Money Earned and Received: I am working and my hourly wage is $. I work hours a week. I am not paid by the hour. I receive a salary in the following amount: per day, per week, per month, OR per year. 4 5 6 7 8 9 I receive commissions or tips each month in the following amount: I receive unemployment benefits each month in the following amount: I receive veterans or social security benefits (retirement, disability, widows, dependents, or survivor) each month in the following amount: I receive child support, spousal support, or alimony each month in the following amount: 20 I receive other sources of income (rent, military basic allowance for quarters (BAH), 2 22 trust payments, etc.) each month in the following amount: I receive pension or annuity payments each month in the following amount: 23 24 25 26 27 28 I am not employed at the present time and am not receiving any kind of income or benefits. (If you have check this box, please explain how you are meeting your basic living needs. For example, are you are living with others who are helping to support you, are you are in a homeless shelter, or are you meeting your needs in other ways? Please explain here) If more room is needed, attach additional sheets. REV 2/209 JCB 4 F6JP APPLICATION
2 3 4 5 6 7 8 9 0 2 3 4 5 6 7 Petitioner 2 s List of Assets and Their Value: Motor Vehicle(s): What is it worth? Amount owed. (Print the Year, Make, and Model) Home or Real Estate other than where you live: What is it worth? Amount owed. (Print the Type of Property) Accounts or Other Personal Property (saving, checking, stocks, bonds, investments, retirement, jewelry, furs, furniture, etc.): (Print the Type of Account) What is it worth? Amount owed. 8 9 Cash in the amount of: 20 2 22 23 24 25 26 27 28 Who lives with you?: Name Age Relationship Monthly contribution to household. If more room is needed, attach additional sheets. REV 2/209 JCB 5 F6JP APPLICATION
2 3 4 5 6 7 8 9 0 2 3 4 If there is additional information you both believe the court should consider, please write it here: If more room is needed, attach additional sheets. 5 6 7 8 9 This document does not contain the personal information of any person as defined by NRS 603A.040. We declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct. 20 2 22 23 24 25 26 27 28 Date: Date: Petitioner s Signature: Petitioner s Name: Petitioner 2 s Signature: Petitioner 2 s Name: REV 2/209 JCB 6 F6JP APPLICATION
INSTRUCTIONS: STEP 2 Do Not File Or Copy This Page Only one person applying to waive the fees and costs needs to fill out this form. Complete the Request for Submission as Shown: You will attach the Order to the Request for Submission using the Index of Exhibits and Exhibit Cover Page. When you upload your documents to eflex you will upload the Request for Submission and the Index of Exhibits as one PDF. ) Print your name, address, telephone number, and email. 2) Print your names in the same order as you have put them on all other documents. The Filing Office will assign you a case number and department number when you file the documents. 3) Print the date that you file the documents. 4) Date, sign, and print your name. REV 2/209 JCB Self Help Center 775-325-673 F-6JP VISUAL INSTRUCTIONS Law Library 775-328-3250 Filing Office 775-328-30 x 7
2 3 4 5 6 7 8 Code: 3860 Name: Address: Telephone: Email: Self-Represented Litigant IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE 9 0 2, and Petitioner, Case No. Dept. No. 3 4 5 6, Petitioner 2. / 7 REQUEST FOR SUBMISSION 8 9 20 I request that the Joint Application to Waive Fees and Costs filed on (Date the form was filed) be submitted to the Court for decision. 2 22 23 This document does not contain the personal information of any person as defined by NRS 603A.040. 24 25 26 27 28 Date: Your Signature: Print Your Name: REV 2/209 JCB REQUEST FOR SUBMISSION
INDEX OF EXHIBITS Exhibit Number Exhibit Number Exhibit Number Exhibit Number Exhibit Number Exhibit Number Exhibit Number Exhibit Number Exhibit Number
Exhibit Cover Page EXHIBIT NUMBER
INSTRUCTIONS: STEP 3 Do Not File Or Copy This Page Prepare the Order Regarding Waiver of Fees and Costs as Shown: You will attach the Order to the Request for Submission using the Index of Exhibits and Exhibit Cover Page. When you upload your documents to eflex you will upload the Exhibit Cover Page and Order as one PDF. ) Print your names in the same order as you have put them on all other documents. The Filing Office will assign you a case number and department number when you file the documents. You do not need to complete any of the other information on this page. REV 2/209 JCB Self Help Center 775-325-673 F-6JP VISUAL INSTRUCTIONS Law Library 775-328-3250 Filing Office 775-328-30 x 7
Code: 3359 / 3359D 2 3 4 5 IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE 6 7 8 9 0, Petitioner, and, Petitioner 2. / Case No. Dept. No. 2 3 4 5 6 7 8 9 20 2 22 23 24 ORDER REGARDING WAIVER OF FEES AND COSTS Upon consideration of the parties declaration of insufficient income, property, or resources to pay Court costs and fees in this case, and other good cause appearing, IT IS HEREBY ORDERED that pursuant to NRS 2.05, the Clerk of the Court shall allow the applicant to proceed with the filing of documents without costs and fees and issue any necessary writ, process, pleading or paper without charge, and that the Sheriff or any other appropriate public officer within the State make personal service of any necessary writ, process, pleading or paper without charge for the said applicant. This Order waives fees until a final order is entered in this case, unless the Court rules otherwise. The Waive of Fees and Costs is DENIED for the following reason: The applicant does not qualify. Other: 25 26 Date: 27 28 DISTRICT JUDGE REV 0/208 JCB F-6JP ORDER
Do Not File Or Copy This Page INSTRUCTIONS: STEP 4 Electronically Filing the Documents You will need to upload the original documents to eflex. EFlex is available online at https://wceflex.washoecourts.com/, and at the Second Judicial District Court Scanners are available at the Second Judicial District Court. Sign into your eflex account using the username and password you created and electronically file the: Joint Application for Waiver of Fees and Costs; Request for Submission and Exhibit Index; and Order Waiving Fees and Costs (as an exhibit **continuation to the Request for Submission). Make sure to keep the original documents you file for your personal records. Filestamped copies of your documents are available through your eflex account. There is no fee for filing this document. INSTRUCTIONS: STEP 5 After Filing Your Documents After you file your documents, take your paperwork to the Family Division Front Counter, 3 rd Floor, One South Sierra Street, to have your application reviewed. Typically, the application will be approved or denied while you wait. REV 2/209 JCB Self Help Center 775-325-673 F-6JP VISUAL INSTRUCTIONS Law Library 775-328-3250 Filing Office 775-328-30 x 7