FW-011

Notice to Appear for 
Reconsideration of Fee Waiver 

Clerk stamps date here when form is filed.

Warning: If you do not go to the hearing on the date and time below, the 
court may cancel your fee waiver.

Name of person who asked the court to waive court fees:

Street or mailing address:

City:

State:

Zip:

Lawyer, if person in      has one: (Name, address, phone number,

1

Fill in court name and street address:

e-mail, and State Bar number):

Superior Court of California, County of

The court has information that (check all that apply): 
a.       Your financial situation may have changed, or you may no
longer be eligible for a fee waiver because (explain):

You may be increasing the costs of your case unnecessarily. The 
fee waiver for the court services you are using may be limited
because (explain):

Fill in case number and name:
Case Number:

Case Name:

Your case is coming to an end, and the court requires some information about your eligibility to have your 
court fees waived.

Name and address of court if different from above:

4

You must go to court on the date below:

(cid:206)

Hearing 
Date

Date:
Dept.:

Time:
Rm.:

Bring the following information if reasonably available:

1

2

3

b. 

c. 

Date:

Request for Accommodations. Assistive listening systems, computer-assisted real-time captioning, or 
sign language interpreter services are available if you ask at least five days before your hearing. Contact the 
clerk’s office for Request for Accommodation, form MC-410. (Civil Code, § 54.8.)

Signature of (check one):       Judicial Officer      Clerk, Deputy

Clerk's Certificate of Service

I certify that I am not involved in this case and (check one):

I handed a copy of this notice to the party and attorney, if any, listed in       and      , at the court, on the date below.

   This notice was mailed first class, postage paid, to the party and attorney, if any, at the addresses listed in       and      ,

2

1

  A certificate of mailing is attached.
2

1

from (city):

Date:

, California on the date below.

Clerk, by

Judicial Council of California, www.courtinfo.ca.gov
New July 1, 2009, Mandatory Form 
Government Code, § 68636

Notice to Appear for Reconsideration 
of Fee Waiver

, Deputy

FW-011, Page 1 of 1