Free Request for Waiver of Prepayment of the Filing Fee - Maryland


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Date: February 28, 2005
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State: Maryland
Category: Court Forms - State
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URL

http://www.courts.state.md.us/family/forms/dr32.pdf

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Preview Request for Waiver of Prepayment of the Filing Fee
Circuit Court for
Name Street Address City State Zip Code Apt. #

Case No.
City or County Name

VS.
Telephone

Street Address City State

Apt. # Zip Code

(

Plaintiff

Area Code

)

(

Defendant (DOM REL 32)

Area Code

)

Telephone

REQUEST FOR WAIVER OF PREPAYMENT OF THE FILING FEE
I, complaint, petition or other paper(s) entitled which I have completed and attached. I am unable to prepay the filing fee because of poverty. The answers to the following questions are true: 1. (a) Do you have any money? How much? Where? , representing myself, wish to file the

Savings Account (bank's name, account number and balance) Checking Account (bank's name, account number and balance) (b) Are you employed? Position How much do you make?(specify monthly, every two weeks, or weekly and the amount) (c) Are you self-employed? Doing what? Where?

How much do you make? (specify monthly, every two weeks, or weekly and the amount) (d) If you are not working, when did you last work? (e) Do you own an automobile? Make, Model and Year To whom?

Is it paid for? _____ How much do you owe?

(f) Does anyone owe you any money? ____ How much? _________ To whom? ( name, address & tel. #. )

(g) Do you own real estate or a house? _______ Value Is it mortgaged? _____ Total owed ____________ Monthly payment (h) Do you receive any rental income? How much?

(i) Do you own any personal property (excluding ordinary household furnishings and clothing)? What is it? (j) Do you receive money from social security, supplemental security income (SSI), worker's compensation or other disability benefits, public assistance, food stamps, settlements, judgments, trust funds, retirement, annuity or pension payments? If so, how much and what is the source?

(k) Do you have any investments?

What and how much?

Interest income (specify monthly or annual) ___________ Dividend income (specify monthly or annual) ___________

Page 1 of 2

DR32 - Revised 10 April 2003

(l) Do you owe money to others (e.g., rent, credit card debts, loan payments, etc)? To whom? (name, address & tel.#) (m) If you are married and living with your spouse, state his/her name. Does your spouse work?_______ His/Her annual income Doing what and where?

How much?

(n) List persons whom you actually support, your relationship to them and the amount you pay in support. (specify
monthly or weekly)

2. Other facts (if any) concerning your inability to prepay the filing fee are:

PRISON INMATES OR THOSE ON WORK RELEASE MUST ANSWER THE ADDITIONAL QUESTIONS BELOW
3. What is your inmate number? _____________ 4. Have you filed any other cases in state or federal court? _____If yes, then for each case state who you sued, the case number and the result of the case. (Attach additional page if more space is needed)

5. Do you have a prison job or other assignment? ______ Employer, assignment and wages

6. Do you have a prison inmate account? ______ What is your account number?____________________________ How much money is in your prison inmate account?

Attach a certified copy of your inmate account statement(s) for at least the last two (2) months.
For these reasons, I request waiver of prepayment of the filing fee. I solemnly affirm on personal knowledge and under the penalties of perjury that the contents of the foregoing paper are true.

(Date)

(Signature) (Address) (City, State, Zip) (Tel. #)
(_________)_________________________________

RESET FORM

Page 2 of 2

DR32 - Revised 10 April 2003

* _______________________________ Plaintiff/Petitioner, v. * _______________________________ Defendant(s), * * * * * * * * *

IN THE CIRCUIT COURT FOR __________________ COUNTY/CITY Civil No.: * * * * *

* * ORDER

Upon consideration/reconsideration of Plaintiff/Petitioner/Defendant's verified Request for Waiver of Prepayment of the Filing Fee, it is, this ORDERED that: day of ,

G G G

The request is GRANTED and the prepayment of the filing fee is waived. The request is GRANTED in part and Plaintiff/Petitioner shall prepay the following portion of the filing fee: $ by , .1

The request is DENIED. The Court has determined that Plaintiff/Petitioner is able to pay the filing fee. See Maryland Rule 1-325(a).

G

The request is DENIED. The Court has determined that claim/appeal is frivolous. See Maryland Rule 1-325(a).

G

The request is DENIED. Plaintiff/Petitioner may request reconsideration by filing the following requested documentation or explanation within date of this Order:

forty-five (45) days from the

Judge
1

The complaint, petition, or other paper will not be docketed unless the required amount is paid by the due date. Page 1 of 1
JO 19 - Revised 17 September 2003