Free Request for Waiver of Prepayment of Court Cost - Hawaii

STATE OF HAWAI`I
FAMILY COURT FIFTH CIRCUIT

REQUEST FOR WAIVER OF PREPAYMENT OF COURT COSTS


CASE NUMBER FCNO. -



This document is prepared by:







VS.

PLAINTIFF/PETITIONER,

Name: Address:

DEFENDANT/RESPONDENT.

Telephone No. (

) -

-

I, the above-named Plaintiff/Petitioner, swear under penalty of perjury that I do not have the resources or income to pay the costs of this matter and request that prepayment of the costs be waived.

DATE

PLAINTIFF/PETITIONER'S SIGNATURE

Reprographics (10/08)

REQUEST FOR WAIVER OF PREPAYMENT OF COURT COSTS 5F-P-167

CLEAR FORM