Illinois Application For Waiver Of Court Fees
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1
2
3This form is approved by the Illinois Supreme Court and is required to be accepted in all Illinois courts.
For Court Use Only
STATE OF ILLINOIS,
CIRCUIT COURT
APPLICATION FOR WAIVER OF
COURT FEES
COUNTY
Instructions
Enter above the
county name where
the case was filed.
Enter the name of the
person who started the
Plaintiff / Petitioner (First, middle, last name)
lawsuit as
Plaintiff/Petitioner.
Enter the name of the
v.
person being sued as
Defendant/Respondent.
Enter the Case
Number given by the
Circuit Clerk or leave
Defendant / Respondent (First, middle, last name)
Case Number
this blank if you do
not have one.
In 1a, enter your full
Pursuant to Illinois Supreme Court Rule 298 and 735 ILCS 5/5-105, I state:
name. If you are
completing this form
1. I am providing the following information about myself:
on behalf of a minor
a. Name:
or an incompetent
adult, provide that
First
Middle
Last
person's information.
b. Year of Birth:
c. Street Address:
In 1b, only enter the
year you were born.
City, State, ZIP:
DO NOT enter your
d. I believe I cannot afford to pay the court fees in this case.
entire date of birth.
In 1c, enter your
2. I am providing the following information about people who live with me:
complete current
address.
a. I support
adults
who live with me.
(not counting myself)
In 2a, enter the number
b. I support
children under 18 who live with me.
of people age 18 and
older living in your
house who you support.
3. I have received 1 or more of the benefits listed below in the past 4 weeks:
Support means that the
people rely on you
Yes
No
financially.
• Supplemental Security Income (SSI) (Not Social Security)
• Aid to the Aged, Blind and Disabled (AABD)
In 2b, enter the number
of people under age 18
• Temporary Assistance to Needy Families (TANF)
living in your house
• State Children & Family Assistance
who you support.
• Food Stamps (SNAP)
In 3, check “Yes” if
• General Assistance (GA)
you have received at
• Transitional Assistance
least 1 of the benefits
listed in the past 4
weeks.
If you check “Yes” in
**If you answered “Yes” in section 3, skip section 4 and sign the form.**
3, skip 4 and sign the
form.
This form shall not be modified. It may be supplemented with additional materials.
WA-P 603.1
Page 1 of 3
(09/14)
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