FW-005

Notice: Waiver of Court Fees 
(Superior Court)

Clerk stamps date here when form is filed.

1

Person who asked the court to waive court fees:
Name:

Mailing address:
City:

Phone number:

State:

Zip:

2

Lawyer, if person in  1 has one: (name, firm name, address, phone
 number, e-mail, and State Bar number):

Fill in court name and street address:

Superior Court of California, County of

Your Request to Waive Court Fees was filed on (date):

Court fills in case number when form is filed.

3

4

Your request is granted by operation of law because no court action was 
taken within five days after it was filed.  A fee waiver is granted for the 
following court fees and costs (Cal. Rules of Court, rule 3.55):

Case Number:

Case Name:

 

•  Making copies and certifying copies   
•  Sheriff’s fee to give notice 

 
•  Filing papers   
 
•  Giving notice and certificates   
 
•  Sending papers to another court department     •  Court fee for phone hearing  
•  Reporter’s fee for attendance at hearing or trial, if the court is not electronically recording the proceeding and you 
    request that the court provide an official reporter 
•  Assessment for court investigations under Probate Code section 1513, 1826, or 1851 
•  Preparing, certifying, copying, and sending the clerk’s transcript on appeal 
•  Holding in trust the deposit for a reporter's transcript on appeal under rules 8.130 or 8.834 
•  Making a transcript or copy of an official electronic recording under rule 8.835

Date:

Clerk, by

, Deputy

Notice: The court may order you to answer questions about your finances and later order you to pay back the waived  
fees. If this happens and you do not pay, the court can make you pay the fees and also charge you collection fees. If there 
is a change in your financial circumstances during this case that increases your ability to pay fees and costs, you must  
notify the trial court within five days. (Use form FW-010.) If you win your case, the trial court may order the other side  
to pay the fees. If you settle your civil case for $10,000 or more, the trial court will have a lien on the settlement in the  
amount of the waived fees. The trial court may not dismiss the case until the lien is paid.

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

Clerk's Certificate of Service

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       ,
from (city):

, California, on the date below.

  A certificate of mailing is attached.

2

1

2

1

Date:

Clerk, by

Judicial Council of California, www.courts.ca.gov  
Revised September 1, 2019,  Mandatory Form  
Government Code, § 68634(f)

Notice: Waiver of Court Fees

, Deputy

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