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Contact the clerk s office for Request for Accommodation form MC-410. Civil Code 54. 8. Clerk s Certificate of Service I certify that I am not involved in this case and check one A certificate of mailing is attached. I handed a copy of this notice to the party and attorney if any listed in 1 and 2 at the court on the date below. FW-011 Notice to Appear for Reconsideration of Fee Waiver Warning If you do not go to the hearing on the date and time below the court may cancel your fee waiver. Clerk stamps date here when form is filed. To keep other people from seeing what you entered on your form please press the Clear This Form button at the end of the form when finished. Name of person who asked the court to waive court fees Street or mailing address City Zip State Lawyer if person in has one Name address phone number Superior Court of California County of e-mail and State Bar number Fill in court name and street address The court has information that check all that apply a. Your financial situation may have changed or you may no longer be eligible for a fee waiver because explain Fill in case number and name Case Number Case Name b. FW-011 Notice to Appear for Reconsideration of Fee Waiver Warning If you do not go to the hearing on the date and time below the court may cancel your fee waiver. Clerk stamps date here when form is filed* To keep other people from seeing what you entered on your form please press the Clear This Form button at the end of the form when finished* Name of person who asked the court to waive court fees Street or mailing address City Zip State Lawyer if person in has one Name address phone number Superior Court of California County of e-mail and State Bar number Fill in court name and street address The court has information that check all that apply a* Your financial situation may have changed or you may no longer be eligible for a fee waiver because explain Fill in case number and name Case Number Case Name b. You may be increasing the costs of your case unnecessarily. The fee waiver for the court services you are using may be limited because explain Your case is coming to an end and the court requires some information about your eligibility to have your court fees waived* You must go to court on the date below c* Name and address of court if different from above Hearing Date Dept. Time Rm* Bring the following information if reasonably available Signature of check one Judicial Officer Clerk Deputy Request for Accommodations. Assistive listening systems computer-assisted real-time captioning or sign language interpreter services are available if you ask at least five days before your hearing. This notice was mailed first class postage paid to the party and attorney if any at the addresses listed in 1 and 2 from city California on the date below. Clerk by Judicial Council of California www*courtinfo*ca*gov New July 1 2009 Mandatory Form Government Code 68636 Deputy of Fee Waiver For your protection and privacy please press the Clear This Form button after you have printed the form* Save This Form Print This Form FW-011 Page 1 of 1..

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