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

FOR COURT USE ONLY

JV-134

RESPONSE TO RECOMMENDATION REGARDING ABILITY 
TO REPAY COST OF  LEGAL SERVICES 

CASE NUMBER:

I, (name):                                                                am a person responsible for the support of the child(ren) named above.

1.

2.

3.

4.

I agree to repay the court for the cost of my legal services in the amount of $                    , as recommended by the financial 
evaluation officer on the accompanying Recommendation Regarding Ability to Repay Cost of Legal Services.

I agree to repay the court for the cost of legal services provided to the child(ren) in this case in the amount of $                   , 
as recommended by the financial evaluation officer on the attached Recommendation Regarding Ability to Repay Cost of 
Legal Services (form JV-133).

I promise to pay $               on the (1st, 2nd, etc.):                    day of every month, beginning on (date):                        until 
the agreed amount is paid in full.

I waive my right to a hearing on the recommendation and understand that the court will order me to pay the 
agreed amount under the terms above.
I understand that if I default on these payment terms, the entire balance will become immediately due and 
payable on demand.

I dispute the recommendation of the financial evaluation officer regarding my ability to pay, and I have requested a hearing 
before the court to review that recommendation.
a.

I understand that a hearing has been scheduled on:

Hearing date:

Time:

Dept./Room:

            at the Court address above

           other (address):

I also understand that if I do not appear at this hearing and do not pay in full the assessed costs for legal 
services, the court may enter a judgment against me based on the financial evaluation officer's 
recommendation without further notice or order.

To be represented by a lawyer and, if I cannot afford a lawyer, to have a lawyer appointed to 
represent me.

I understand that I am entitled to the following at the hearing:

The opportunity to be heard in person;
The opportunity to present witnesses and written evidence;
The opportunity to confront and cross-examine witnesses brought against me;

Disclosure of the evidence against me;

A written statement of the findings of the court; and

• • • • • •

5.

I understand that at any time before I complete payment of the full amount ordered by the court, I may petition the court to change 
its judgment if a change in circumstances affects my ability to pay the judgment.

I declare under penalty of perjury under the laws of the State of California that the above information is true and correct.

Date:



( SIGNATURE OF RESPONSIBLE PERSON)

Page 1 of 1

Form Approved for Alternative Optional Use 
Instead of Form JV-136
Judicial Council of California 
JV-134 [New January 1, 2013]

RESPONSE TO RECOMMENDATION REGARDING ABILITY 
TO REPAY COST OF  LEGAL SERVICES 

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

a.

b.

b.

c.

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):