ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FOR COURT USE ONLY

JV-133

TELEPHONE NO.:

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF  

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CHILD(REN)'S NAME(S):

RECOMMENDATION REGARDING ABILITY TO REPAY 
COST OF LEGAL SERVICES 

CASE NUMBER:

On (date):                                         , (name):                                                      , a person responsible for the support of the children 
named above, was ordered to report for an evaluation to determine his or her ability to reimburse the court's cost of legal services 
provided directly to him or her or to the children named above in this case.                        

The responsible person:

has been reunified with the children under a court order. Repayment would harm his or her ability to support the children. I 
do not, therefore, petition the court for an order of repayment. 

did not appear as ordered or respond to the order. As required by law, I recommend and petition that the court 
order that person to repay the full cost of legal services, in the amount of $ 

did appear as ordered. Based on an interview concerning his or her financial condition and an analysis of his or her 
financial declaration and supporting documentation, I find that the responsible person (check all that apply):

a.

b.

c.

is unable to repay the costs of the legal services in this case.

is able to repay the cost of legal services provided directly to him or her in the amount of $            .

is able to repay the cost of legal services provided to the child(ren) named above in the amount of 
$             and

(1)

(2)

has agreed to repayment on the terms set forth on the accompanying Response to 
Recommendation Regarding Ability to Repay Cost of Legal Services. I petition the court to 
order repayment on these terms.

disputes this assessment of his or her ability to repay the assessed costs and has 
requested a hearing.

A hearing is scheduled:

Date:

Time:

Dept./Room:

           at Court address above            other (specify address):

The responsible person is ordered to appear at the above time and place without further notice.

1.

2.

3.

Date:

(NAME OF FINANCIAL EVALUATION OFFICER)

(SIGNATURE OF FINANCIAL EVALUATION OFFICER)

Form Approved for Alternative Optional Use 
Instead of Form JV-136
Judicial Council of California 
JV-133 [New January 1, 2013]

RECOMMENDATION REGARDING ABILITY TO REPAY 
COST OF LEGAL SERVICES 

Welfare and Institutions Code, §§ 903.1, 
903.45(b), 903.47
www.courts.ca.gov

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