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Es): Name: Street or mailing address: City: State: SAMPLE ONLY Do not fill out this form Zip: Phone number: 2 Fill out item #1. Fill out #2 if you have a lawyer. Your lawyer, if you have one(name, address, phone number, e-mail, and State Bar number): Fill in court name and street address: Superior Court of California, County of 3 Date of order denying your request to waive court fees (month/day/year): (Check here if you have a copy of the order denying your In #3, write the date of req.

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