FW-003, Order on Court Fee Waiver (Superior Court) Completed Form Examples and Samples
Explore detailed examples and samples of the completed FW-003, Order on Court Fee Waiver (Superior Court) form. Understand how to interpret a filled FW-003, whether your request is granted, denied, or requires more information, with our clear, annotated samples.
FW-003 Example: Order Granting Fee Waiver Based on Public Benefits
How this form was filled:
This is an example of a completed FW-003 form where the court grants a fee waiver. The applicant, Jane A. Smith, had her request approved because she receives public benefits (box 2a is checked). The order, signed by a judicial officer, waives initial and subsequent court fees and costs (box 2c(1) is checked).
Information used to fill out the document:
- Petitioner/Plaintiff: Jane A. Smith
- Respondent/Defendant: John C. Doe
- Attorney for Petitioner: In Pro Per
- Court Name: Superior Court of California, County of Los Angeles
- Street Address: 111 North Hill Street
- City, State, Zip Code: Los Angeles, CA 90012
- Branch Name: Stanley Mosk Courthouse
- Case Number: 26FLDC12345
- Order Status: Granted (Box 2 checked)
- Reason for Grant: Applicant receives public benefits (Box 2a checked)
- Waived Fees: Court fees and costs listed in FW-001, item 5 (Box 2c(1) checked)
- Judicial Officer: Emily Carter
- Date of Order: 01/22/2026
What this filled form sample shows:
- Clearly filled header with court, party, and case information.
- Indicates the fee waiver request was granted by checking box 2.
- Specifies the legal basis for the waiver as receipt of public benefits (box 2a).
- Details the scope of the waiver, covering initial and future court fees (box 2c(1)).
- Includes a sample Judicial Officer's signature and date to finalize the order.
Form specifications and details:
| Use Case: | Court order granting a fee waiver for an individual receiving government benefits. |
| Form Name: | FW-003, Order on Court Fee Waiver (Superior Court) |
| Jurisdiction: | California Superior Court |
| Filing Party: | Court/Judicial Officer |
Created: February 16, 2026 04:32 PM
