Form AWA-A1303.5 "Application for Waiver of Court Fees (Appellate Court)" - Illinois

What Is Form AWA-A1303.5?

This is a legal form that was released by the Illinois Appellate Court - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2020;
  • The latest edition provided by the Illinois Appellate Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AWA-A1303.5 by clicking the link below or browse more documents and templates provided by the Illinois Appellate Court.

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Download Form AWA-A1303.5 "Application for Waiver of Court Fees (Appellate Court)" - Illinois

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I
This form is approved by the Illinois Supreme Court and is required to be used in all Illinois Appellate Courts.
Instructions
THIS APPEAL INVOLVES A MATTER SUBJECT TO EXPEDITED DISPOSITION UNDER
RULE 311(a).
Check the box to the
right if your case
involves parental
responsibility or
parenting time
(custody/visitation
rights) or relocation of a
Appellate Case No.:
child.
Enter the Appellate
Court case number, if
IN THE APPELLATE COURT OF
you have it.
ILLINOIS
Just below “In the
Appellate Court of
Illinois,” enter the
District
number of the appellate
district where the appeal
was filed.
Appeal from the Circuit Court
If the case name in the
In re
of
County
trial court began with
“In re” (for example,
“In re Marriage of
Trial Court Case No.:
Jones”), enter that
name. Below that, enter
the names of the parties
Plaintiff/Petitioner in the trial court (First, middle, last names)
as they appeared in the
trial court, and check
Appellant
Appellee
Honorable
the correct boxes to
show which party filed
the appeal (“appellant”)
v.
Judge, Presiding
and which party is
responding to the appeal
(“appellee”).
Defendant/Respondent in the trial court (First, middle, last names)
To the far right, enter the
trial court county, trial
Appellant
Appellee
court case number, and
trial judge's name.
APPLICATION FOR WAIVER OF COURT FEES
(APPELLATE COURT)
If you are completing this form on behalf of a minor or an incompetent adult, provide that person's
NOTE:
information on this form instead of your own information.
In 1a, enter your full
Pursuant to
Illinois Supreme Court Rule
313(f),
Illinois Supreme Court Rule 298
and
name.
735 ILCS
5/5-105, I state:
In 1b, only enter the
year you were born.
DO NOT enter your
1. I believe I cannot afford to pay the court fees in this case and I am providing the
entire date of birth.
following information about myself:
a.
Name:
In 1c, enter your
complete current
First
Middle
Last
address.
b.
Year of Birth:
c.
Street Address:
In 2, if you are
currently incarcerated,
City, State, ZIP:
attach a copy of your
inmate trust fund ledger
2. I am currently incarcerated.  Yes  No If yes, inmate I.D. #
for the last 6 months or
your Application will
If yes, I am attaching a copy of my inmate trust fund ledger for the last six (6) months.
be rejected.
**If you answered “Yes” in section 2, skip section 3, 4, and 5 and sign below.**
AWA-A 1303.5
Page 1 of 3
(03/20)
I
This form is approved by the Illinois Supreme Court and is required to be used in all Illinois Appellate Courts.
Instructions
THIS APPEAL INVOLVES A MATTER SUBJECT TO EXPEDITED DISPOSITION UNDER
RULE 311(a).
Check the box to the
right if your case
involves parental
responsibility or
parenting time
(custody/visitation
rights) or relocation of a
Appellate Case No.:
child.
Enter the Appellate
Court case number, if
IN THE APPELLATE COURT OF
you have it.
ILLINOIS
Just below “In the
Appellate Court of
Illinois,” enter the
District
number of the appellate
district where the appeal
was filed.
Appeal from the Circuit Court
If the case name in the
In re
of
County
trial court began with
“In re” (for example,
“In re Marriage of
Trial Court Case No.:
Jones”), enter that
name. Below that, enter
the names of the parties
Plaintiff/Petitioner in the trial court (First, middle, last names)
as they appeared in the
trial court, and check
Appellant
Appellee
Honorable
the correct boxes to
show which party filed
the appeal (“appellant”)
v.
Judge, Presiding
and which party is
responding to the appeal
(“appellee”).
Defendant/Respondent in the trial court (First, middle, last names)
To the far right, enter the
trial court county, trial
Appellant
Appellee
court case number, and
trial judge's name.
APPLICATION FOR WAIVER OF COURT FEES
(APPELLATE COURT)
If you are completing this form on behalf of a minor or an incompetent adult, provide that person's
NOTE:
information on this form instead of your own information.
In 1a, enter your full
Pursuant to
Illinois Supreme Court Rule
313(f),
Illinois Supreme Court Rule 298
and
name.
735 ILCS
5/5-105, I state:
In 1b, only enter the
year you were born.
DO NOT enter your
1. I believe I cannot afford to pay the court fees in this case and I am providing the
entire date of birth.
following information about myself:
a.
Name:
In 1c, enter your
complete current
First
Middle
Last
address.
b.
Year of Birth:
c.
Street Address:
In 2, if you are
currently incarcerated,
City, State, ZIP:
attach a copy of your
inmate trust fund ledger
2. I am currently incarcerated.  Yes  No If yes, inmate I.D. #
for the last 6 months or
your Application will
If yes, I am attaching a copy of my inmate trust fund ledger for the last six (6) months.
be rejected.
**If you answered “Yes” in section 2, skip section 3, 4, and 5 and sign below.**
AWA-A 1303.5
Page 1 of 3
(03/20)
Enter the Case Number given by the Appellate Court Clerk: _________________________________
3. I am providing the following information about people who live with me:
In 3a, enter the number
of people age 18 and
a. I support
adults
who live with me.
(not counting myself)
older living in your
b. I support
children under 18 who live with me.
house who you
support. Support
means that the people
4. I have received 1 or more of the benefits listed below in the past 4 weeks:
rely on you financially.
 Yes  No
In 3b, enter the number
• Supplemental Security Income (SSI) (Not Social Security)
of people under age 18
• Aid to the Aged, Blind and Disabled (AABD)
living in your house
• Temporary Assistance to Needy Families (TANF)
who you support.
• State Children & Family Assistance
• SNAP (Food Stamps)
In 4, check “Yes” if
you are currently
• General Assistance (GA), Transitional Assistance or State Children and Family
receiving 1 or more of
Assistance.
the benefits listed
below.
**If you answered “Yes” in section 4, you qualify for a fee waiver under
If you check “Yes” in
4, skip 5 and sign the
. You can
735 ILCS 5/5-105(a)(2)(i) and (b)(1)
skip section 5 and sign the form.**
form. You do not have
to complete 5.
5. I checked “No” in section 4, so I am providing the following financial information:
a.
I have applied for 1 or more of the benefits listed in section 4:
In 5a, check “Yes” if
you have applied for at
 Yes  No
least 1 of the benefits
listed in section 4.
I receive the following money each month.
b.
(check all that apply)
 Social Security (not SSI):
In 5b, check the box
 My employment: $
$
for each type of money
 Unemployment:
 Child support:
$
$
you have received in
 Pension:
$
the past month. Also
enter the gross (before
 Money from other household members:
$
taxes) amount for each
 Other
:
$
(list type and amount)
type.
 No income
Total of all money received in the past month: $
Under Other in 5b and
5c, include any money
received from family
c.
I received the following total amount of money in the past 12 months.
(check all that apply)
or friends.
 Social Security (not SSI): $
 My employment: $
 Child support:
$
 Unemployment:
$
In 5c, check the box
for each type of money
 Pension:
$
you have received in
 Money from other household members:
$
the past 12 months.
Also enter the gross
 Other
$
(list type and amount):
(before taxes) amount
 No income
for each type.
Total of all money received in the past 12 months: $
My current monthly debts and expenses are listed below.
In 5d, check all of your
d.
(check all that apply)
debts and expenses for
 Rent:
$
per month
the past month and list
 Home
$
per month
the amount of money
you pay each month
 Other Mortgage:
$
per month
for that expense.
 Utilities:
$
per month
 Food:
$
per month
 Medical:
$
per month
 Car Loan:
$
per month
 Childcare
$
per month
 Child Support
$
per month
AWA-A 1303.5
Page 2 of 3
(03/20)
Enter the Case Number given by the Appellate Court Clerk: _________________________________
 Other expenses not listed above
:
(list type and amount)
$
 Other debts not listed above
:
(list type and amount)
$
 I have no expenses
Total of all expenses: $
per month
In 5e, check all of the
e.
I have the belongings listed below.
(check all that apply)
items owned by you
 Bank accounts and cash totaling:
$
and list the value of
 Home worth:
$
each item. If you own
real estate, include the
The total I owe on my home mortgage is:
$
total you owe on any
 Other real estate, not including the house I live in, worth:
$
mortgage.
The total I owe on my other mortgage is:
$
 1
vehicle worth: $
The 1
vehicle is paid off:  Yes  No
st
st
 2
vehicle worth: $
The 2
vehicle is paid off:  Yes  No
nd
nd
 Other
:
$
(list items and value)
 None of the above
Under Illinois Supreme
Court Rule 137, your
signature means that
you have read the
document, that to the
best of your belief, it is
true and correct and
that you are not filing
/s/
it for an improper
Your Signature
Street Address
purpose, such as to
cause delay.
If you are completing
Print Your Name
City, State, ZIP
this form on a
computer, sign your
name by typing it. If
you are completing it
Relationship to Minor or Incompetent
Telephone
by hand, sign by hand
Adult (if applicable)
and print your
name. Enter your
complete current
address and telephone
number.
If you are filling out
this form for a minor
or incompetent adult,
sign and print your
name and state your
relationship to that
person. Enter your
complete current
address and telephone
number.
GETTING COURT DOCUMENTS BY EMAIL: If you agree to receive court documents by email, check the box below and enter your email
address. You should use an email account that you do not share with anyone else and that you check every day. If you do not check your email
every day, you may miss important information or notice of court dates. Other parties may still send you court documents by mail.
I agree to receive court documents at this email address during my entire case.
Email
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