QUESTIONNAIRE FOR FILING FEE WAIVER

OTHER TYPES OF MONTHLY INCOME - IF YOU ANSWER "YES" TO ANY QUESTION, YOU MUCH INDICATE THE MONTHLY AMOUNT YOU RECEIVE

INFORMATION ABOUT YOUR ASSETS

INFORMATION ABOUT YOUR DEBTS

A person who knowingly provides false information to the clerk or the court in seeking a determiniation of indigent status under F.S. 57.082 commits a misdemeanor of the first degree, punishable as provided in FS 775.082 or FS 775.083.