APPLICATION FOR WAIVER OF FEES AND COSTS F-6 The District Court Filing Office is located on the first floor at: 7 Court Street Reno, NV 890
APPLICATION TO WAIVE FEES AND COSTS PACKET F-6 Do Not Copy Or File This Page USE THIS APPLICATION ONLY IF THE FOLLOWING REQUIREMENT IS MET: You 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:. Application for Waiver of Fees and Costs. Order Regarding Waiver of Fees and Costs. Request for Submission The penalty for willfully making a false statement under penalty of perjury is a minimum of year, and a maximum of years in prison, in addition to a fine of not more than $,000.00. N.R.S. 99. REV /0 ER F-6 VISUAL INSTRUCTIONS
INSTRUCTIONS: STEP Application to Waive Fees and Costs Do Not Copy Or File This Page ) Print your name, address, telephone number, and email. ) Print the names of the parties. The case number and department number will be provided when you file your documents. ) Print your name here. ) Each section of the Application has a box with instructions. Please follow the instructions and complete pages -. REV /0 ER F-6 VISUAL INSTRUCTIONS
Code: 866 Name: Address: Telephone: Email: Self-Represented Litigant IN THE FAMILY DIVISION 6 OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 7 IN AND FOR THE COUNTY OF WASHOE 8 9 0, Plaintiff / Petitioner, Case No. Dept. No. vs., Defendant / Respondent. / APPLICATION TO WAIVE FEES AND COSTS 6 I,, declare that, pursuant to (Print Your Name) 7 NRS.0, I am requesting permission from this Court to proceed without paying court costs or 8 9 other costs and fees because I cannot afford to pay such expenses. I. 0 Monthly Benefits Received: Check each box that applies to you. You may need to check more than one box. If you are not receiving any of the benefits listed, proceed to section II. 6 7 8 I receive benefits from one or more of the following programs (please check all that apply): Supplemental Security Income (SSI); Families (TANF); Medicaid; Food Stamps; Temporary Assistance for Needy Subsidized Housing through Reno Housing Authority; Client of Legal Services. Rev. //0 APPLICATION TO WAIVE FEES AND COSTS
II. Monthly Money Earned and Received: Check each box that applies to you and fill in the information requested. You may need to check more than one box. 6 I am working and my hourly wage is. I work hours per week. 7 I am not paid by the hour; I receive a salary in the following amount: 8 9 0 per year OR per month. I receive commissions or tips each month in the following amount: $ I receive unemployment benefits each week in the amount of: $ I receive veterans or social security benefits (retirement, disability, widows, dependents or survivor) each month in the following amount: 6 I receive child support, spousal support or alimony each month in the 7 8 9 following amount: $ $ I receive pension or annuity payments each month in the following amount: $ 0 I receive other sources of income (such as rent, military basic allowance for quarters (BAQ), veterans payments, annuities, or trust payments) each month in the following amount: 6 I am not employed at the present time and am not receiving any kind of income or benefits. (If you have checked this box, please explain how you are meeting your basic living needs. For 7 example, are you living with others who are helping to support you, are you in a homeless 8 Rev. //0 APPLICATION TO WAIVE FEES AND COSTS
shelter or are you meeting your needs in other ways? Please explain here): If more room is needed, attach additional sheets. 6 III. 7 List of Assets and Their Value 8 Check each box that applies to you and fill in the information requested. 9 You may need to check more than one box. 0 Motor Vehicle(s): What is it worth? Amount owed. What is it worth? Amount owed. (Print the Year, Make, and Model) (Print the Year, Make, and Model) 6 (Print the Year, Make, and Model) 7 8 Home or Real Estate other than where you live: 9 0 Accounts or Other Personal Property (saving, checking, stocks, bonds, investments, retirement, jewelry, furs, furniture, etc.): (Print the Type of Account ) (Print the Type of Account ) 6 7 I have cash in the amount of: 8 Rev. //0 APPLICATION TO WAIVE FEES AND COSTS
IV. People Who Live in Your Home: Include only your spouse, children and other people in the home who you help to support or who help to support you. When listing children please include only their initials rather than their first and last names. If a person helps support you, list the amount of money they contribute each month. 6 7 Name Age Relationship 8 9 0 6 Gross Monthly Income () () () () () (6) (7) (8) 7 If more room is needed, attach additional sheets. 8 9 If there is additional information you believe the court should consider, please write it here: 0 6 7 8 Rev. //0 APPLICATION TO WAIVE FEES AND COSTS
If more room is needed, attach additional sheets. 6 7 This document does not contain the Social Security Number of any person. I declare under penalty of perjury, under the law of the State of Nevada, that the foregoing statements are true and correct. 8 DATED: Signature: 9 0 Print Your Name: 6 7 8 9 0 6 7 8 Rev. //0 APPLICATION TO WAIVE FEES AND COSTS
INSTRUCTIONS: STEP Preparing the Order Regarding Waiver of Fees and Costs Do Not Copy Or File This Page ) Print the names of the parties. The case number and department number will be provided when you file your documents. ) Print your name here. STOP HERE The Court will fill out the rest of the form. REV /0 ER F-6 VISUAL INSTRUCTIONS
Code: 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 Plaintiff / Petitioner, vs. 9 0 Case No. Dept. No. Defendant / Respondent. / ORDER REGARDING WAIVER OF FEES AND COSTS Upon consideration of s declaration of insufficient income, property, or resources to pay Court costs and fees in this case, and other good 6 cause appearing, 7 IT IS HEREBY ORDERED that pursuant to NRS.0, the Clerk of the Court shall 8 allow the applicant to proceed with the filing of documents without costs and fees and issue any 9 necessary writ, process, pleading or paper without charge, and that the Sheriff or any other appropriate 0 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 Waiver of Fees and Costs is DENIED for the following reason: The applicant does not qualify. Other: 6 DATED this day of, 0. 7 DISTRICT JUDGE / COURT MASTER 8 REV /0 ER
INSTRUCTIONS: STEP Completing the Request for Submission Form Do Not Copy Or File This Page ) Print your name, address, telephone number, and email. ) Print the names of the parties, the case number and department number just as they appear on all other documents in this case. ) Print the date you filed the Application to Waive Fees and Costs. ) Date, sign, and print your name on the form. REV 8/0 ER F-6 VISUAL INSTRUCTIONS
Code: 860 Name: Address: Telephone: Email: Self-Represented Litigant IN THE FAMILY DIVISION 6 OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 7 IN AND FOR THE COUNTY OF WASHOE 8 9 0, Plaintiff / Petitioner / Joint Petitioner, Case No. Dept. No. vs., Defendant / Respondent / Joint Petitioner. REQUEST FOR SUBMISSION 6 I request that the Application to Waive Fees and Costs filed on 7 8 (Date the form was filed) be submitted to the Court for decision. 9 This document does not contain the Social Security Number of any person. 0 Date: Signature: Print Your Name: 6 7 8 REV 08/0 ER REQUEST FOR SUBMISSION
INSTRUCTIONS: STEP Copying and Filing Documents Take the original and two () copies of the completed forms to the filing clerk's office to be filed. Each form must be individually stapled. The filing office will not accept forms that are not stapled. The filing clerk s office is located on the first floor of the courthouse at 7 Court Street, Reno, NV. A copy machine is available at the Law Library located on the first floor of the courthouse at 7 Court Street, Reno, NV (to the left of the filing clerk s office). There is a per page charge to use the copy machine. After Filing Your Documents After you file your documents in the filing office, take your paperwork to the Family Division Front Counter, rd Floor, One South Sierra Street, to have your Application reviewed. The Family Division is in the building directly across Sierra Street. Do Not Copy Or File This Page REV /06 ER F-6 VISUAL INSTRUCTIONS
Legal Assistance The information in this packet is provided as a courtesy only. This packet is not a substitute for the advice of an attorney. Counsel is always recommended for legal matters. If you do not have an attorney, you are encouraged to seek the advice of a licensed attorney or visit the Family Court Self Help Center which is located at One South Sierra Street, Reno, NV. The Self Help Center cannot give legal advice but can give information regarding court procedures. You may also wish to speak with a family law lawyer at no cost through the Law Library s Family Law Lawyer in the Library program, or to seek assistance from other free or reduced-cost legal resources in the area, to include: FAMILY LAW LAWYER IN THE LIBRARY First Floor (to the left of the filing office) of the courthouse located at: 7 Court Street, Reno, NV 890 (77) 8-0 www.washoecourts.com/lawlib Tuesday Evenings, from :00 p.m. 7:00 p.m. (Arrive by :0 p.m.) *Please Note* The program is limited to 0 participants each evening. NEVADA LEGAL SERVICES 0 Marsh Avenue Reno, NV 8909 (77) 8-9 x leave message if necessary http://nlslaw.net WASHOE LEGAL SERVICES 99 S. Arlington Avenue Reno, NV 890 (77) 9-77 leave message if necessary http://www.washoelegalservices.org Do Not Copy Or File This Page REV 8/0 ER F-6 VISUAL INSTRUCTIONS