
Your Information (person with a fee waiver):
Name:
Street or mailing address:
Zip:
State:City:
Phone number:
Your lawyer, if you have one (name, address, phone number, e-mail,
and State Bar number:
Date of your last court fee waiver order in this case:
(date)
My financial situation has changed since the date of the last court fee waiver order in a way that improves my
ability to pay fees. I ask the court to do one of the following:
a. End my fee waiver because my financial situation has improved and I am able to pay my court fees and
costs that are due after (date): .
b. Review my updated financial information in the attached Request to Waive Court Fees. I believe I am still
eligible for a fee waiver. (Complete form FW-001 and attach to this form.)
My case has settled for (check one) less than $10,000 $10,000 or more (if so, complete a and b below.)
I declare under penalty of perjury under the laws of the State of California that the information above is true
and correct.
Date:
Print your name here Sign here
FW-010,
Page 1 of 1
CONFIDENTIAL
Notice to Court of Improved
Financial Situation or Settlement
Clerk stamps date here when form is filed.
FW-010
a. I (check one) have have not received the proceeds of the settlement.
b. The name and address of the party who has agreed to pay the settlement:
Notice to Court of Improved
Financial Situation or Settlement
Judicial Council of California, www.courtinfo.ca.gov
New July 1, 2009, Mandatory Form
Government Code, § 68636(a)
Notice: The court may order you to answer questions about your finances and later order you to pay back the waived
fees. If this happens and you do not pay, the court can make you pay the fees and also charge you collection fees. If
there is a change in your financial circumstances during this case that increases your ability to pay fees and costs, you
must notify the trial court within five days. (Use form FW-010.) If you win your case, the trial court may order the other
side to pay the fees. If you settle your civil case for $10,000 or more, the trial court will have a lien on the settlement in
the amount of the waived fees. The trial court may not dismiss the case until the lien is paid.
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Case Number:
Case Name:
Superior Court of California, County of
Fill out court name and street address:
Fill out case number and case name: