Application & Declaration Form For Deferral Or Waiver Of Fees
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N THE
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FOR THE
OUNTY OF
Case No. _____________________
Plaintiff/Petitioner
Application & Declaration for
v.
Deferral or Waiver of Fees for:
Plaintiff/Petitioner
Defendant/Respondent
Defendant/Respondent
ACCESS TO THIS DOCUMENT IS RESTRICTED TO PROTECT THE PRIVACY OF PARTIES
I am asking for deferral or waiver of fees in this case because I am unable to pay all or part of the
fees right now. I understand that I must complete the Declaration for Deferral or Waiver
of Fees to prove to the court that I do not have enough money to pay the fees. I understand that
if I do not, my request can be denied.
1. I am applying for deferral or waiver of the following fees (check ONE box ONLY):
Filing Fees
Filing Fees + Sheriff’s Service Fee*
Motion Fee
Arbitration Fee
Trial Fee
Other
:
(describe)
*If you are requesting deferral or waiver of the sheriff’s service fee, explain why you cannot find
another person to serve the papers. Papers can be served by any competent person who is at
least 18 years old, a resident of Oregon (or the state where service is made), and who is not a
party to the case or a party’s lawyer, employee, officer, or director.
2. If the court defers fees, I understand that:
a. The fees are a debt I owe to the State of Oregon, and the court may put me on a
payment plan. I agree to pay the fees according to the payment plan. If I fail to do so,
the total amount of unpaid fees will be referred for collection.
b. The court will enter a judgment against me for the unpaid amount of the fees that are
deferred, and the judgment will be enforced regardless of the outcome of the case.
c. If the court refers this judgment for collection, administrative and collection costs will
automatically be added to the judgment without further notice to me or further action
by the court.
3.
I understand that if the clerk denies my application, I have the right to ask a judge to review
my application.
Fee Deferral or Waiver Application and Declaration (eForm: 11/9/12)
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