Name 

 
Address 

 
Phone 
 
Email 

 
City, State, Zip 

 
 
 
 
 
 
 
 

 

In the  [  ] District  [  ] Justice  Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

_____________________________________ 
Plaintiff/Petitioner 

v. 

_____________________________________ 
Defendant/Respondent 

Order on Motion to Waive Fees 
(Inmates) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

_______________________________ 
Commissioner (domestic cases) 

The matter before the court is a Motion to Waive Fees. Having reviewed the Motion to 
Waive Fees and Statement Supporting Motion and supporting financial evidence, and 
having made an independent determination, 

The court orders: 

1. 

[  ]  The motion is denied. The information shows that the party is reasonably 

able to pay the fees.  

2. 

[  ]  The motion is denied. The party failed to provide the required information. 

The party may re-file the motion with the required information within 14 days. 

3. 

[  ]  The motion is granted. The following fees are waived. If the fee is waived in 

part, it is because the party is reasonably able to pay the balance.  

1303GEJ Approved June 24, 2019 / 
Revised April 25, 2022  
 

Order on Motion to Waive Fees (Inmates) 

Page 1 of 3 

 

 

Waived in 
Full 
[  ] 

Waived in Part – 
Amount to be Paid 

Fee 

Filing fee  

OCAP fee  

Divorce classes 

education class fees 
orientation class fees 

Vital stats fee – divorce certificate or report of 
adoption  

Fee to have papers served within Utah 

Other (Describe.) 
 

[  ] 
 
[  ] 
[  ] 

[  ] 

[  ] 

[  ] 

 

 

 

 

 

 

4. 

[  ]  The moving party must pay the fees as determined above, but since they 

are unable to pay the full amount at this time: 

The party must pay an initial fee of $________________, which is 50% of 
the party’s current trust account balance or 10% of the party’s six-month 
aggregate disposable income, whichever is greater. 

Each month until the fees are paid in full, the agency having custody of the 
party shall garnish 20% of the party’s aggregate disposable income for the 
preceding month and, when the amount collected exceeds $10, pay the 
amount to the clerk of the court. 

Any fees not waived must be paid within 30 days or the case may be dismissed. 

This order is subject to review and amendment for so long as the court has 
jurisdiction of the case. 

udge’s signature may instead appear at the top of the first page of this document. 

Signature ► 

 

 

Judge 

1303GEJ Approved June 24, 2019 / 
Revised April 25, 2022  
 

Order on Motion to Waive Fees (Inmates) 

Page 2 of 3 

5. 

6. 

    J

 

 
Date 

Notice to the Moving Party 

If the fee waiver was denied because the judge found you are reasonably able to pay 
(paragraph 1 is marked), and you: 

•  have lost your source of income; 
•  have unaccounted expenses limiting your ability to pay; 
•  will suffer immediate irreparable harm if the action is delayed; or 
•  would lose the opportunity to file the case because of the delay,  

you may file a Memorandum Demonstrating Inability to Pay Fees within 10 days of the 
date of this order. 

If the fee waiver was denied because you failed to provide the required information 
(paragraph 2 is marked), and you want your request to be reconsidered, you must file a 
corrected motion with the required information within 14 days of the date of this order. 

Clerk’s Certificate of Service 

I certify that on ____________________ (date) a copy of this order was mailed to the 
moving party at this address: 

 
Date 

Signature ► 

 

 

Printed name of court clerk 

   

     

 

1303GEJ Approved June 24, 2019 / 
Revised April 25, 2022  
 

Order on Motion to Waive Fees (Inmates) 

Page 3 of 3