Fee Waiver Forms
for Determining Eligibility for Waiver
of Fees, Costs, or Security in Civil Cases
in the West Virginia Courts
From May 1, 2003, until Directed Otherwise
by Administrative Order of the Chief Justice
(W.Va. Code §59-2-1, Circuit Court Civil Rule 77(e), and Magistrate Court Civil Rule 22)
In making determinations of eligibility for waiver of fees, costs or security, authorized court personnel shall be mindful of citizens' right of access to the court and right to the benefit of court services.
A. Initial Determination of Eligibility for Waiver by Clerk or Deputy Clerk
If the amount in Line C1 of the affidavit is less than the amount shown in the income chart below for the number of dependents listed in Line C2b of the affidavit AND the amount in Line C3 minus $500 is less than the amount in Line C4b of the affidavit, THEN the application for waiver should be granted UNLESS the amount in Line C5b of the affidavit is more than the income chart amount.
B. Review of Eligibility for Waiver by the Court
The Court may take into account all information provided in the affidavit, any evidence submitted in the action, and the income chart below, and may require the party alleging eligibility for waiver to provide additional information, beyond the affidavit, satisfactory to the Court.
** YOU MUST ATTACH A COPY OF YOUR MOST RECENT SALARY STUB, W-2 FORM, OR OTHER FINANCIAL DOCUMENTATION (WITH ALL SOCIAL SECURITY NUMBERS AND ALL DATES OF BIRTH REMOVED (YOU CAN BLACK THEM OUT)) THAT VERIFIES YOUR INCOME. WITHOUT THE ATTACHED DOCUMENTATION, YOUR APPLICATION WILL BE INCOMPLETE AND NOT CONSIDERED.
To download the Financial Affidavit and Application please click here.