Amador — FW-001-GC

Source: https://amador.courts.ca.gov/system/files/forms-and-filings/fw001gc.pdf

Request to Waive Court Fees FW-001-GC CONFIDENTIAL (Ward or Conservatee) Clerk stamps date here when form is filed. This form must be used by a guardian or conservator, or by a petitioner for the appointment of a guardian or conservator, to request a waiver of court fees in the guardianship or conservatorship court proceeding or in any other civil action in which the guardian or conservator represents the interests of the ward or conservatee as a plaintiff or defendant. If the ward or conservatee (including a proposed ward or conservatee if a petition for appointment of a guardian or conservator has been filed but has not Fill in court name and street address: yet been decided by the court) directly receives public benefits or is supported Superior Court of California, County of by public benefits received by another for his or her support, is a low-income person, or does not have enough income to pay for his or her household’s basic needs and the court fees, you may use this form to ask the court to waive the court fees. The court may order you to answer questions about the finances of the ward or conservatee. If the court waives the fees, the ward or conservatee, his or her estate, or someone with a duty to support the ward or conservatee, Fill in case number and name: may still have to pay later if: • You cannot give the court proof of the ward’s or conservatee’s eligibility, Case Number: • The ward’s or conservatee’s financial situation improves during this case, or • You settle the civil case on behalf of the ward or conservatee for $10,000 or Case Name: more. The trial court that waives fees will have a lien on any such settlement in the amount of the waived fees and costs. The court may also charge the ward or conservatee, or his or her estate, any collection costs. 1 Your Information (guardian or conservator, or person asking the court to appoint a guardian or conservator): Name: Phone: Street or mailing address: City: State: Zip: 2 Your Lawyer (if you have one): Name: Firm or Affiliation: State Bar No.: Address: Phone: City: State: Zip: Email: a. The lawyer has agreed to advance all or a portion of court fees or costs (check one): Yes No b. (If yes, your lawyer must sign here.) Lawyer’s signature: If your lawyer is not providing legal-aid type services based on your or the ward’s or conservatee’s low income, you may have to go to a hearing to explain why you are asking the court to waive the fees. 3 Ward's or Conservatee's Information (file a separate Request for each ward in a multiward case): Name: Age and date of birth (ward only): Street or mailing address: City: State: Zip: Phone: 4 Ward's or Conservatee's Lawyer, if any: Name: Firm or Affiliation: State Bar No.: Address: Phone: City: State: Zip: Email: 5 Ward or Conservatee's Job (job title; if not employed, so state): Name of employer: Employer’s address: State: Zip: Judicial Council of California, www.courts.ca.gov FW-001-GC, Page 1 of 4Rev. August 1, 2022, Mandatory Form Request to Waive Court Fees Government Code, § 68633 (Ward or Conservatee)California Rules of Court, rules 3.51, 7.5

Name of (Proposed) Ward or Conservatee: Case Number:

6 What court's fees or costs are you asking to be waived? Superior Court (See Information Sheet on Waiver of Superior Court Fees and Costs (form FW-001-INFO).) Supreme Court, Court of Appeal, or Appellate Division of Superior Court (See Information Sheet on Waiver of Appellate Court Fees (form APP-015/FW-015-INFO).) 7 Check here if you asked the court to waive court fees for this case in the last six months. (If your previous request is reasonably available, please attach it to this form and check here): 8 Why are you asking the court to waive the ward’s or conservatee’s court fees? a. The ward or one or both of the ward’s parents, or the conservatee or the conservatee’s spouse or registered domestic partner, receive (check all that apply): Supplemental Security Income (SSI) State Supplemental Payment (SSP) SNAP (Food Stamps) IHSS (In-Home Supportive Services) CalWORKS or Tribal TANF Medi-Cal County Relief/General Assistance CAPI (Cash Assistance Program for Aged, Blind, and Disabled) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program) Unemployment Compensation (Names and relationships to ward or conservatee of persons who receive the public benefits listed above):

b. The gross monthly income of the ward’s or conservatee’s household (before deductions for taxes) is less than
the amount listed below. (If you check 8b, you must fill out items 14, 15, and 16 on page 4 of this form.)*
Family Size Family Income Family Size Family Income Family Size Family Income If more than 6 people
1 $2,265.00 3 $3,838.34 5 $5,411.67 at home, add $786.67
2 $3,051.67 4 $4,625.00 6 $6,198.34 for each extra person.
c. The ward’s or conservatee’s household does not have enough income to pay for its basic needs and the court
fees. I ask the court to (check one, and you must fill out items 14, 15, 16, 17, and 18 on page 4):*
(1) Waive all court fees and costs. (2) Waive some court fees and costs.
(3) Let the (proposed) guardian or conservator, on behalf of the (proposed) ward or conservatee, make
payments over time.

• (Do not include income of guardian or conservator living in the household in 8b or 8c or count him or her in family size in 8b. unless he or she is a parent of the ward or the spouse or registered domestic partner of the conservatee.) Guardians or petitioners for their appointment must complete items 9 and 10.

9 Ward's Estate: Person only, no estate. Inventory or petition estimated value: Source (e.g., gift, inheritance, settlement, judgment, insurance): Est. collection date:

10 Ward's Parents' Information: a. Name of ward’s father: Deceased (date of death): Street or mailing address: City: State: Zip: Phone: b. Name of ward’s mother: Deceased(date of death): Street or mailing address: City: State: Zip: Phone: c. Ward’s parents are (check all that apply): married living together separated divorced Support order for ward? No Yes Payable to (name): Payor (name): Court: Case Number: Date of order (if multiple, date of latest): Monthly amount: Rev. August 1, 2022 Request to Waive Court Fees FW-001-GC, Page 2 of 4 (Ward or Conservatee)

Name of (Proposed) Ward or Conservatee: Case Number:

Conservators or petitioners for their appointment must complete items 11–13.

11 Conservatee's Estate: Person only, no estate. Inventory or petition estimated value: Est. collection date: 12 Conservatee's Spouse’s or Registered Domestic Partner's Information: Name of conservatee’s spouse or registered domestic partner: Spouse Partner Date of marriage or partnership: Deceased (date of death): Street or mailing address: Phone: City: State: Zip: Name of employer (if none, so state): Employer’s address: State: Zip: The conservatee’s spouse or partner is is not managing, or following appointment of a conservator is planning to manage, some or all of the couple’s community property outside the conservatorship estate. If you selected “is” above: The income, money, and property shown on page 4 includes does not include the income and property managed, or expected to be managed, by the spouse/partner outside the estate. Divorced (date of final judgment or decree ): Court: Case Number: Support order for conservatee? No Yes Date of support order (if multiple, date of latest): Monthly amount:

13 The Conservatee and Trusts: The conservatee: a. is is not a trustor or settlor of a trust. b. is is not a beneficiary of a trust. If you selected “Is” to complete any of the above statements, identify and provide, in an attachment to this Request, the current address and telephone number of the current trustee(s) of each trust, describe the general terms of and value of each trust and the nature and value of the conservatee’s interest in each trust, and the amount(s) and frequency of any distributions to or for the benefit of the conservatee prior to your appointment as conservator of which you are aware. (You may use Judicial Council form MC-025 for this purpose.)

All applicants who checked item 8b or item 8c on page 2 must continue to and follow the instructions for completion of items 14–16 or items 14–18 on page 4, before signing below.

The information I have provided on this form and all attachments about the (proposed) ward or conservatee is true and correct to the best of my information and belief. The information I have provided on this form and all attachments concerning myself is true and correct. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

Print your name here Sign here

Rev. August 1, 2022 Request to Waive Court Fees FW-001-GC, Page 3 of 4 (Ward or Conservatee)

Name of (Proposed) Ward or Conservatee: Case Number:

If you checked 8a on page 2, do not fill out below. If you checked 8b, you must answer questions 14–16. If you checked 8c, you must answer questions 14–18. If you need more space, attach form MC-025 or attach a sheet of paper, and write "Financial Information" and the ward’s or conservatee’s name and case number at the top. 14 Check here if the ward’s or conservatee’s income changes a lot 17 Ward's or Conservatee's Household's Money and Property from month to month. If it does, complete the form based on his or a. Cash $ her average income for the past 12 months. b. All financial accounts (list bank name and amount): 15 Ward's or Conservatee's Gross Monthly Income (1) $ a. List the source and amount of any income the ward or conservatee (2) $ gets each month, including: wages or other income from work (3) $ before deductions, spousal/child support, retirement, social security, disability, unemployment, military basic allowance for quarters c. Cars, boats, and other vehicles Fair Market How Much You (BAQ), veterans payments, dividends, interest, trust income, Make / Year Value Still Owe annuities, net business or rental income, reimbursement for job- (1) $ $ related expenses, gambling or lottery winnings, etc. (2) $ $ (1) $ (3) $ $ (2) $ d. Real estate Fair Market How Much You (3) $ Address Value Still Owe (4) $ (1) $ $ (5) $ (2) $ $ b. Total monthly income: $ e. Other personal property (jewelry, furniture, furs, stocks, 16 Ward's or Conservatee's Household's Income bonds, etc.): Fair Market How Much You a. List the income of all other persons living in the ward’s or conservatee’s Describe Value Still Owe home who depend in whole or in part on him or her for support, or on (1) $ $ whom he or she depends in whole or in part for support. (2) $ $ Name Age Relationship Gross Monthly Income 18 Ward's or Conservatee's Household's Monthly (1) $ Deductions and Expenses (2) $ a. List any payroll deductions and the monthly amount below: (3) $ (4) $ (1) $ (5) $ (2) $ (6) $ (3) $ (4) $ (7) $ b. Rent or house payment and maintenance $ (8) $ c. Food and household supplies $ (9) $ d. Utilities and telephone $ (10) $ e. Clothing $ b. Total monthly income of persons above: $ f. Laundry and cleaning $Total monthly income and ho

e. Clothing $ b. Total monthly income of persons above: $ f. Laundry and cleaning $Total monthly income and ho

e. Clothing $ b. Total monthly income of persons above: $
f. Laundry and cleaning $Total monthly income and
household income (15b plus 16b): $ g. Medical and dental expenses $
h. Insurance (life, health, accident, etc.) $
i. School, child care $

To list any other facts you want the court to know, such as the j. Child, spousal support (another marriage) $ (proposed) ward’s or conservatee’s unusual medical expenses, k. Transportation, gas, auto repair and insurance $ etc, attach form MC-025 or attach a sheet of paper and write l. Installment payments (list each below): “Financial Information” and the (proposed) ward’s or Paid to: conservatee’s name and case number at the top. (1) $ (2) $ Check here if you attach another page. (3) $ Important! If the ward’s or conservatee’s financial situation or m. Wages/earnings withheld by court order $ ability to pay court fees improves, you must notify the court n. Any other monthly expenses (list each below). within five days on form FW-010-GC. Paid to: How Much? Do not include income of guardian or conservator living (1) $ in the household in item 16, his or her money and (2) $ property in item 17, or his or her deductions and expenses (3) $ in item 18 unless he or she is a parent of the ward or the Total monthly expenses $ spouse or registered domestic partner of the conservatee. (add 18a –18n above): Rev. August 1, 2022 Request to Waive Court Fees FW-001-GC, Page 4 of 4 (Ward or Conservatee) For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form