Transcription of APPLICATION FOR WAIVER OF …
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Example: tourism industry
APPLICATION FOR WAIVER OF …
Page 1 of 2 Clicking on the question marks ( ) will give you information about that section of the Monthly Expenses*J. Other (medical, dental, child support paid, alimony paid, etc.) (Specify):1. Dependents (another person who is supported by you)2. Monthly Income3. Monthly ExpensesTotal number of dependents (not including yourself)A. Gross monthly income (before deductions)..B. Net monthly income after taxes from monthly Other income (for example, TANF, Social Security, child support, alimony, etc.) (Specify which one(s) here):Total Monthly Income (B+C)*A. Real Estate Utilities (telephone, fuel heat, electric, water, gas, cable, etc.)..D. Food (less SNAP (food stamps), if any)..E. Insurance Premiums (medical/dental, auto, life, home)..G. Transportation (bus, gasoline, etc.)..I.
JD-FM-75 Rev. 2-15. Page 2 of 2. The application for waiver of the payment of a fee or fees or the cost of service of process is DENIED because the applicant has
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