Free IN THE CIRCUIT COURT OF THE STATE OF OREGON - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF _____________________ ______________________________________,
Petitioner/Plaintiff,

v. ______________________________________,
Respondent/Defendant.

) ) ) ) ) ) )

Case No. _________________ FEE WAIVER OR DEFERRAL RECOMMENDATION AND ORDER

CLERK'S RECOMMENDATION OR ORDER (to be completed by court clerk) I have reviewed (applicant name) _______________________________________'s application for waiver or deferral of fees and RECOMMEND ORDER the following:

DENIAL of the applicant's request for waiver or deferral of fees because: the applicant is financially able to pay the fees (see part __________ of the Declaration); the application is not complete or contains insufficient information (see part _________ of the Declaration); the applicant has not shown proof of current eligibility for public benefits; or _________________________________________________________________________.

WAIVER of the applicant's fees in whole or in part. Total Fees $ _______________ The applicant is RECOMMENDED Amount to be Waived $ ______________ ORDERED to pay:

$ ____________

in full by (date) ________________. pursuant to a schedule to be established by court staff. by a payment schedule of $ __________ today and $ __________ on the same day of each month until paid.

DEFERRAL of the applicant's fees. The applicant is RECOMMENDED ORDERED to pay:

$ ____________

in full by (date) ________________. pursuant to a schedule to be established by court staff. by a payment schedule of $ __________ today and $ __________ on the same day of each month until paid.
________________
Date

______________________________________ _____________________________________
Signature of Clerk Name of Clerk (printed or typed)

Fee Waiver or Deferral Recommendation and Order OJIN Code: ORFW (Order Fee Waiver), ORFD (Order Fee Deferral), or ORDN (Order of Denial)

Page 1 of 2

JUDGE'S ORDER (to be completed by judge)

The clerk's recommendation is AFFIRMED. The clerk's recommendation is MODIFIED or I ORDER as follows: The applicant's request for waiver or deferral of fees is DENIED because: the applicant is financially able to pay the fees (see part _______ of the Declaration); the application is not complete or contains insufficient information (see part ____, of the Declaration); or __________________________________________________________________.

The applicant's fees are WAIVED in whole or in part. Total Fees $ _______________ The applicant is ORDERED to pay: $ ____________ in full by (date) ________________. pursuant to a schedule to be established by court staff. by a payment schedule of $ __________ today and $ __________ on the same day of each month until paid. Amount Waived $ ______________

The applicant's fees are DEFERRED. The applicant is ORDERED to pay: $ ____________ in full by (date) ________________. pursuant to a schedule to be established by court staff. by a payment schedule of $ __________ today and $ __________ on the same day of each month until paid.

Other findings __________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

___________________________
Date

_____________________________________
Signature of Judge

_____________________________________
Name of Judge (printed or typed)

Fee Waiver or Deferral Recommendation and Order OJIN Code: ORFW (Order Fee Waiver), ORFD (Order Fee Deferral), or ORDN (Order of Denial)

Page 2 of 2